THROMBOLYTIC TREATMENT OF ACUTE ON CHRONIC LEG ISCHEMIA

The efficacy of thrombolysis was retrospectively studied in patients w ith acute on chronic ischaemia in the lower extremity. A total number of 68 thrombolytic treatments were given to 65 patients, 58 (85 %) bec ause of native arterial occlusions and 10 (15 %) because of occluded g rafts. Tissue plasminogen activator was the lytic agent used in all pa tients. In native arteries, thrombolysis alone was successful in 15 (5 2 %) out of 29 legs, whereas 22 (85 %) out of 26 thrombolyses followed by angioplasty or surgery were effective. Thrombolysis alone was succ essful in two and failed in five out of 10 occluded grafts. Patency wa s achieved by combination with surgery in the other three cases. Twelv e-month patency was 34 % after thrombolysis alone and 69 % (P < 0.05) when combined with surgery or angioplasty. The 30-day mortality rate w as 9 %. Thrombolysis can be used alone in acute on chronic ischaemia i n the lower extremities. The immediate and the long-term results are c learly improved when thrombolysis is combined with angioplasty or reco nstructive surgery to treat the underlying cause.