ISOLATED LIMB THROMBOLYSIS WITH EXTRACORPOREAL PUMP AND UROKINASE

In order to determine the effect of altering the method of delivery of lytic therapy, both hind limbs of 55 adult mongrel dogs were embolize d to occlusion and divided into six different treatment groups. Each r ight limb received 100,000 units of urokinase (UK) intraarterially by one of six different treatment protocols: Group I (n = 10), 5-min infu sion with control of arterial inflow (IC); Group II (n = 10), 5-min in fusion without IC; Group III (n = 10), 30-min infusion with IC; Group IV (n = 10), 30-min infusion without IC (simulates percutaneous infusi on); Group V (n = 10), isolated limb perfusion (ILP) with femoral arte rial and venous cannulation and proximal tourniquet control using an e xtracorporeal circulating pump at a controlled rate and constant tempe rature (37 degrees C) for 30 min; Group VI (n = 5), underwent ILP with out urokinase. A morphometric score was used to quantitate angiographi c changes. Films were compared before and after treatment and the net difference for each animal was recorded. [GRAPHICS] We conclude that m aintenance of blood flow during urokinase infusion enhances its effect iveness and, contrary to previous recommendations, during intraoperati ve delivery, inflow should be maintained. Isolated limb perfusion alon e was as effective as a 30-min infusion of urokinase without inflow co ntrol. Isolated limb perfusion plus UK was by far the most effective m ethod of administrating lytic therapy. These experiments suggest that the mechanical action of flowing blood enhances clot dissolution and s ignificantly increases the effectiveness of pharmacologic lysis. Isola ted limb fibrinolytic perfusion may have clinical potential in the sur gical treatment of limb ischemia. (C) 1994 Academic Press, Inc.