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Intra-arterial urokinase versus surgery for acute peripheral arterial occlusion
B L Neudeck1, K Blumenschein, E D Endean
1College of Pharmacy, University of Michigan, Ann Arbor, USA.
Insights
Intra-arterial urokinase treatment for acute peripheral arterial occlusion (PAO) resulted in shorter hospital stays and fewer infections compared to surgery. Outcomes like amputation rates and mortality showed no significant differences between treatments.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Pharmacological Interventions
Background:
- Acute peripheral arterial occlusion (PAO) is a critical condition requiring timely intervention.
- Treatment options for PAO include surgical revascularization and endovascular therapies.
- Comparing the efficacy and safety of different PAO treatment modalities is essential for clinical decision-making.
Purpose of the Study:
- To compare the clinical outcomes of intra-arterial urokinase infusion versus surgical intervention for acute peripheral arterial occlusion (PAO).
- To evaluate differences in length of stay, infectious complications, amputation rates, hospital costs, and mortality between the two treatment groups.
Main Methods:
- A retrospective study comparing patients treated with intra-arterial urokinase for PAO with a matched cohort who underwent surgery.
- Patients were pair-matched based on comorbidities, age, sex, and occlusion site.
- Inclusion criteria limited the study to patients with category I or II ischemia.
Main Results:
- Patients receiving intra-arterial urokinase experienced a significantly shorter median hospital stay (8.5 days) compared to the surgery group (13 days).
- The urokinase group had significantly fewer infectious complications (2 vs. 10).
- No significant differences were observed in amputation rates, total hospital costs, or mortality between the urokinase and surgery groups.
Conclusions:
- Intra-arterial urokinase is a viable treatment option for acute peripheral arterial occlusion (PAO), offering advantages in reduced hospital stay and infectious complications.
- For selected patients with acute peripheral arterial occlusion (PAO), intra-arterial urokinase may be preferred over surgery due to improved short-term outcomes.
- Further research may explore long-term outcomes and cost-effectiveness of intra-arterial urokinase in managing acute peripheral arterial occlusion (PAO).
Abstract:
The outcomes of intra-arterial urokinase versus surgery for acute peripheral arterial occlusion (PAO) were compared. Patients at a university hospital who had received intraarterial urokinase for PAO were identified by computer and pair-matched on the basis of comorbidities, age, sex, and site of occlusion to computer-selected patients who had undergone surgery. Only patients with category I or II ischemia were considered. The study period for the urokinase group was February 1995 through January 1996, and the period for the surgery group was June 1993 through January 1996. Twenty-eight patients in each group met the selection criteria. Patients who had received urokinase had a significantly shorter median length of stay (8.5 days) than patients in the surgery group (13 days) and significantly fewer infectious complications (2 versus 10). No differences in amputation rates, total hospital costs, or mortality rates were detected. Patients who received intra-arterial urokinase for PAO had a shorter length of stay in the hospital and fewer infectious complications than those who underwent surgery.