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Isolated limb perfusion with urokinase for acute ischemia
1Department of Surgery, University of Sydney, NSW, Australia.
Journal of Vascular Surgery
|February 1, 1993
Summary
Isolated limb perfusion with urokinase successfully salvaged an acutely ischemic lower limb in a patient unresponsive to other treatments. This method demonstrated safety and efficacy, warranting further investigation for limb salvage.
Area of Science:
- Vascular Surgery
- Thrombolytic Therapy
Background:
- Acute limb ischemia poses a significant risk of limb loss.
- Salvaging acutely ischemic limbs often requires advanced therapeutic strategies when conventional treatments fail.
Observation:
- Isolated limb perfusion with urokinase was administered over 90 minutes for acute ischemia of the left leg.
- The patient had failed previous balloon embolectomy and heparin therapy.
- Perfusion increased arterial bed capacity, with fibrinogen and plasminogen levels remaining low in the isolated circulation.
Findings:
- Angiography confirmed thrombus clearance and improved arterial visualization post-perfusion.
- Clinical assessment showed restoration of limb viability, correlating with angiographic results.
- D-dimer levels rose in the isolated circulation but remained normal systemically.
Implications:
- Isolated limb perfusion with urokinase is a potentially safe and effective treatment for acute limb ischemia.
- This technique shows promise for limb salvage in complex cases.
- Further research is recommended to explore the full potential of urokinase perfusion.