Lysis block treatment: a new form of local thrombolysis

Lysis block treatment (LBT) is a new form of fibrinolytic therapy for deep vein thrombosis and arterial occlusion in the distal parts of the limbs. Strictly local lysis was achieved by placing a cuff around the thigh or the upper arm, inflating the cuff to a pressure of 500 mmHg ("Bier's blockade"), and giving heparin and tissue plasminogen activator (rt-PA) by intravenous injection into the dorsal pedis or antecubital veins. Occlusion lasted for one hour. This new technique was demonstrated in 22 patients. Six patients presented with popliteal vein thromboses and 1 patient with a distal femoral vein thrombosis. In addition, 15 arterial occlusions were treated comprising 3 calf, 6 popliteal, 3 distal femoral, and 2 digital sites and 1 brachial site. Five of 7 venous and 9 of 15 arterial occlusions were partially or totally removed. The activated partial thromboplastin time remained nearly unchanged during LBT and only a limited and short-term lengthening was recorded after restoration of blood flow. This was of importance for patients with bleeding tendencies, which are normally a contraindication for systemic lysis. LBT may therefore be considered as a useful alternative to systemic fibrinolytic treatment.