Local thrombolysis in arterial occlusive disease

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Thromboembolic occlusions pose significant risks to limb viability.
• Systemic thrombolysis has limitations, including contraindications in certain patient groups.
• Localized infusion techniques may offer improved safety and efficacy.

Purpose of the Study:

• To evaluate the efficacy and safety of direct intra-arterial infusion of streptokinase (SK) and urokinase (UK) for treating acute and chronic limb occlusions.
• To assess the success rate, duration of treatment, and potential complications of this localized thrombolytic approach.
• To determine the applicability of this technique in patients unsuitable for systemic thrombolysis.

Main Methods:

• Intra-arterial catheters were used to infuse SK or UK proximal to acute occlusions or directly into chronic occlusions.
• Catheters were advanced stepwise to reach distal open arterial segments.
• Dosages of SK ranged from 50,000 to 400,000 U, administered over 1 to 4 hours. Some patients also underwent immediate angioplasty.

Main Results:

• Vessel patency was achieved in 16 of 20 acute occlusions and 16 of 23 chronic occlusions.
• A systemic hyperlytic state (12–24 hours) occurred with SK doses exceeding 80,000 U.
• The technique demonstrated rapid effectiveness, high success rates in chronic femoro-popliteal occlusions, and was applicable to elderly or high-risk patients.

Conclusions:

• Direct intra-arterial thrombolysis with SK or UK is a highly effective treatment for acute and chronic limb occlusions.
• This localized approach offers rapid restoration of blood flow, cost-effectiveness, and a favorable safety profile, particularly in contra-indicated patients.
• The technique is a valuable alternative to systemic thrombolysis and can be combined with angioplasty for enhanced outcomes.