Percutaneous intraarterial thrombolysis: analysis of factors affecting outcome

The authors report results of high-dose thrombolytic therapy in native arteries and vein grafts and discuss the various factors affecting outcome.

In a retrospective study, the outcome of 82 high-dose urokinase infusions in 76 patients was examined. Comorbid risk factors as they relate to outcome were studied extensively with log-linear analysis. Positive thrombolytic outcome (PTO) is defined as complete thrombolysis of a previously occluded segment with restoration of antegrade flow augmented by angioplasty or operative intervention to clear symptoms for 30 days.

The procedure resulted in a PTO in 63 of 82 instances (77%). The treatment was with urokinase alone in 39 cases (47%) and urokinase followed by surgery in 34 (41%), by angioplasty in four (5%), and by angioplasty in the proximal artery and peripheral vein grafting in five (6%). All stenoses associated with grafts were treated surgically. None of the following affected thrombolytic outcome: age of occlusion, heparin dose, catheter type, length or location of graft, or artery versus graft occlusion. The 30-day mortality was 6.1%, with a procedure-related mortality rate of 2.4%. Overall amputation rate was 18% (74% for patients in whom lysis failed by 30 days).

The presence of at least one runoff vessel was the most important factor affecting outcome (PTO, 95%; P = .00001, chi 2). The most important comorbid risk factor for failed thrombolysis was coronary artery disease (P = .03, chi 2).