THE IMPACT OF THROMBOLYTIC THERAPY ON ARTERIAL AND GRAFT OCCLUSIONS -A CRITICAL ANALYSIS

Background. The indications for intraarterial thrombolytic therapy of lower extremity native arterial and synthetic graft occlusions prior t o vascular reconstructions requires further refinement before firm con clusions can be made. Study design. A retrospective review of 55 patie nts undergoing 81 lytic treatments with high dose urokinase from Febru ary 1989 to February 1993 was performed, The cases were divided into t hree groups: Group I: successful thrombolysis with residual defects fo llowed by surgical reconstruction or percutaneous transluminal angiopl asty (PTA); Group II: successful thrombolysis alone;and Group III: fai lure of thrombolysis requiring reconstruction or leading to amputation No effort was made to analyze the particular type of reconstruction, Follow-up ranged from 1 to 1627 days (4 years and 5 1/2 months). Resul ts. One, two, and three year patency rates were 47%, 24%, and 8% for G roup I; 57%, 46%, and 46% for Group II; and 24%, 10%, and 10% for Grou p III respectively, The one, two and three year limb salvage rates wer e 92%, 76%, and 76% for Group I; 82%, 82%, and 82% for Group II; and 4 8%, 37%, and 37% for Group III respectively, Forty-one complications o ccurred in 35 of the 81 (43%) lytic treatments. Conclusions. Intraarte rial thrombolytic therapy can be regarded as a possible consideration in the initial management of acute lower-extremity arterial and synthe tic graft occlusions especially in patients with multiple prior vascul ar reconstructions. Unsuccessful thrombolysis results in a poor outcom e despite surgical reconstruction in the majority of cases.