Thrombolytic therapy for acute arterial occlusion.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Acute arterial occlusion presents a significant clinical challenge, often requiring surgical intervention.
• Selective intra-arterial low-dose thrombolytic therapy (SILDT) emerged as a potential less invasive alternative.
• Evaluating SILDT's efficacy and safety is crucial for optimizing treatment strategies.

Purpose of the Study:

• To assess the effectiveness of SILDT compared to surgical management for acute arterial occlusions.
• To determine SILDT's success rates in native arterial versus graft occlusions.
• To identify complications associated with SILDT.

Main Methods:

• Retrospective review of 43 SILDT treatments (streptokinase or urokinase) in 40 patients.
• Patients categorized into native arterial occlusion (group 1) and graft occlusion (group 2).
• Success defined as obviating the need for subsequent surgery.

Main Results:

• SILDT success rate was 45% (13/28) in native arterial occlusions, particularly those complicating percutaneous transluminal angioplasty (PTA).
• SILDT success rate was only 21% (3/14) in prosthetic or autogenous graft occlusions, often leading to amputation.
• Significant morbidity (44%) included hemorrhage, embolism, myocardial infarction, and clot migration, necessitating close monitoring.

Conclusions:

• SILDT is most effective for acute arterial thrombosis secondary to arteriography or PTA.
• Its role is limited in prosthetic/autogenous graft occlusions.
• Thrombolytic therapy requires careful monitoring due to significant associated risks.