[Local thrombolytic treatment of peripheral arterial thrombosis and embolism]

Local intra-arterial low-dose thrombolysis has become a therapeutic alternative for acute and subacute occlusion of vascular grafts and native vessels in the lower limbs. The series comprises 31 patients treated with Streptokinase as thrombolytic agent. Complete primary thrombolysis was achieved in 20 patients, whereas in 11 patients the outcome was only partially successful or a failure. Vascular stenoses were considered to precipitate thrombosis in 18 cases, and prompted percutaneous transluminal angioplasty after thrombolysis. Two-year patency was 48% (30-66%) in the total series and 74% (56-92%) among the patients with successful primary thrombolysis. There were no major complications. Five patients sustained local inguinal haemorrhage, of whom three required surgical revision. Local intra-arterial thrombolysis is an elaborate procedure associated with potential hazardous complications. It should be carried out in institutions with radiological and vascular surgical expertise.