Related Experiment Videos
Thrombolytic therapy for arterial occlusion: a mixed blessing
C M Smith1, A E Yellin, F A Weaver
1Department of Surgery, University of Southern California School of Medicine.
The American Surgeon
|May 1, 1994
Summary
Intra-arterial thrombolytic therapy using urokinase (UK) for severe peripheral vascular disease showed a 62% technical success rate. However, this treatment carries significant risks, including major complications and mortality.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Thrombolytic Therapy
Background:
- Arterial occlusive disease necessitates effective treatment options.
- Intra-arterial thrombolytic therapy has emerged as a critical intervention.
- Outcomes and complication rates of thrombolytic therapy remain variable.
Purpose of the Study:
- To review institutional outcomes of intra-arterial thrombolytic therapy.
- To assess the efficacy and safety of urokinase (UK) in treating peripheral vascular disease.
- To analyze complication rates and patient outcomes associated with UK therapy.
Main Methods:
- Retrospective review of 41 patients (42 lower extremities) treated from 1988-1992.
- Intra-arterial urokinase (UK) infusion with heparin anticoagulation.
- Doses ranged from 250,000 units loading to 100,000 units/hour infusion for up to 72 hours.
Main Results:
- Technical success (occlusion resolution) achieved in 62% of cases.
- Immediate clinical success (pulse restoration/ABI increase) in 22/26 technically successful procedures.
- Major complications occurred in 43% of patients, including thromboembolism, dissection, and hemorrhage; two deaths occurred.
Conclusions:
- Intra-arterial thrombolysis with urokinase (UK) offers significant benefits for selected patients with extremity ischemia.
- Concomitant endovascular intervention can enhance treatment success.
- High rates of serious complications, including mortality, necessitate careful patient selection and monitoring.