Surgical implications of fibrinolytic therapy

Intraarterial fibrinolytic therapy was used in 37 cases (34 patients) of severe peripheral ischemia. Nineteen patients (56 percent) required surgical intervention (5 amputations and 14 successful reconstructive procedures). Twenty-four patients (71 percent) were significantly improved (average ankle-to-arm index 0.84), whereas only 5 patients (15 percent) lost their limbs. Five patients were angiographically unchanged with no or slight improvement in the ankle-to-arm index (0.22 to 0.32) and were discharged on anticoagulant therapy. One death and two cerebrovascular accidents occurred. The usefulness of intraarterial fibrinolytic therapy needs to be evaluated within the total realm of vascular surgery. It offers options for therapy where previously none existed. Some situations might be treated equally well with either intraarterial fibrinolytic therapy or surgery. Finally, surgery might be required to maintain initial successful results with intraarterial fibrinolytic therapy or to rescue intraarterial fibrinolytic therapy failures in striving to achieve superior results in limb salvage.