[Urokinase in refractory lower leg ulcers: therapy with retrograde intravenous pressure infusion]

20 patients with large, resistant leg ulcers were treated by retrograde local intravenous pressure infusions containing 100,000 to 200,000 I.U. of urokinase 3 times per week for a total of up to 12 weeks. Laser-Doppler flowmetry and transcutaneous oxygen measurement at the ulcer borders showed highly pathological findings before therapy demonstrating a severe disturbance of local microcirculation in every case. After therapy the clinical condition was markedly improved in 17 cases. There was an increase of Laser-Doppler indices (peak flux/resting flux) and of tc pO2 and a statistically significant decrease of plasma viscosity and of plasma fibrinogen. The beneficial effects may be explained by fibrinolysis of intra- and extracapillary fibrin and by hemodynamic changes caused by repeated limb occlusions.