Intra-arterial streptokinase as adjuvant therapy for complicated Buerger's disease: early trials

Selective low-dose intra-arterial streptokinase was used in 11 long standing, complicated cases of Buerger's disease of the lower limbs suffering from acute exacerbations or thrombotic episodes with resulting variable degrees of gangrene or pre-gangrene of toes or feet, often despite previous lumbar sympathectomy. They had no other possible therapeutic options but wait for major amputation. The overall success rate (with amputation avoided or altered) was 58.3% and bleeding complications occurred in 16.6% of the total limbs at risk included. Favorable factors influencing the therapeutic outcome of thrombolytic therapy were a shorter presentation time, previous sympathectomy and nicotine abstinence. Even with necessary precautions, the technique does not seem to be totally safe. However it can be rewarded in some properly selected cases.