[Thrombotic and thromboembolic occlusions of leg arteries and bypasses. Short-term versus long-term lysis]

Since thrombolytic therapy is less invasive than operative thrombectomy, it is often used as initial treatment for thrombotic or thrombo-embolic occlusions of lower limb arteries or by-passes. We compared four patient groups with acute and subacute occlusions: 1. 19 patients with occluded by-passes treated by rapid lysis using 15.5 (2.5-35) mg rt-PA. 2. 12 patients with by-pass occlusions treated with initial rt-PA in a dose of 6.5 (2.5-12.5) mg followed by prolonged lysis with 5.6 (2.5-10) x 10(6) units of urokinase. 3. 16 patients with arterial occlusions treated by rapid lysis with 15 (2.5-25) mg rt-PA. 4. 14 patients with arterial occlusions given 10.5 (2.5-60) mg rt-PA followed by overnight treatment with 5.9 (2.5-15) x 10(6) units of urokinase. For by-pass recanalisation, prolonged lysis overnight had a success rate of 83% (10/12) which was better than short term lysis with a success rate of 74% (14/19). Similar results were obtained in arterial occlusions with a success rate of 86% (12/14) compared with 69% (11/16). Long term lysis did, however, have significantly more complications. In about one-third of cases further procedures had to be used in addition to lytic therapy.