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Abstract
We have treated 13 patients with limb-threatening ischemia caused by acute arterial
thrombosis with selective arterial infusion of streptokinase. The indications for
thrombolytic therapy included medical contraindication to surgery, surgically inaccessible
thrombi, arterial thrombosis following percutaneous transluminal angioplasty, and
thrombosed distal arterial bypass. Patients were evaluated with arteriography, Doppler
segmental arterial pressure studies, and coagulation profile. Objective evidence of
complete or partial thrombolysis was demonstrated in 11 of the 13 patients (85%).
Treatment after thrombolytic therapy included percutaneous transluminal angioplasty
in six patients and distal bypass in two patients. Of five patients who had received
no additional treatment, three required amputation. Overall limb salvage was achieved
in 10 of the 13 patients. The most serious complications were puncture site bleeding
in five patients, acute renal failure in one patient, and retroperitoneal hemorrhage
in another patient. Bleeding was more frequent in patients with decreased serum fibrinogen
levels. Although lysis of acute arterial thrombi can be achieved, thrombolytic therapy
alone will allow limb salvage in only a few patients. Selective thrombolytic therapy
with streptokinase must be used with caution and is associated with serious complications.
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References
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Article info
Footnotes
☆Presented at the Sixth Annual Meeting of the Midwestern Vascular Surgical Society, Milwaukee, Wis., Sept. 24–25, 1982.
Identification
Copyright
© 1983 Published by Elsevier Inc.
