INTRAARTERIAL UROKINASE FOR ACUTE NATIVE ARTERIAL-OCCLUSION OF THE LIMBS

Since 1988, 49 limbs of 47 patients underwent intraarterial urokinase infusion for acute native artery occlusion. The time from the onset of ischemic symptoms ranged from I to 45 days (mean = 17.5). The arteria l sectors involved were femoropopliteal in 32 cases, followed by aorto iliac in 13 cases, distal in three cases, and subclavian in one case. Treatment consisted of placing a catheter in the clot and the infusion of 4400 U/kg in 20', followed by a series of 4400 U/kg weight/hour du ring 6 hours. Clinical evaluation, hemodinamic and coagulation paramet ers, and angiographical changes were assessed periodically. Infusion t ime ranged from 6 to 24 hours (mean = 13.2 hours). improvement of isch emia was achieved in 43 (87.75%) patients. In five patients (12.25%) t here was no improvement. Total immediate lysis was achieved in 35 case s (71.5%), and among them, 13 patients (26%) required no associated tr eatment, 16 (48%) underwent PTA, and four (12%) had surgery of underly ing peripheral aneurysms revealed after thrombolysis. Partial lysis wa s achieved in 13 cases (26.5%), that was enough in four of them, but t he remaining nine required further treatment (four PTA, and five arter ial surgery). In one case no lysis was achieved, and arterial surgery was carried out. No mortality was recorded, and major complications in cluded one upper gastrointestinal bleeding, and one cerebral hematoma. Late follow-up of successfully treated patients who did not require f urther surgery shows a cumulative patency rate of 81% at 24 months.