PERIPHERAL ARTERIAL OCCLUSIONS - LOCAL LOW-DOSE THROMBOLYTIC THERAPY WITH RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR (RT-PA)

Objective: To study the efficacy and risks of local thrombolytic thera py of peripheral arterial occlusions using rt-PA. Design: This open st udy wets performed in one clinic in Munich, Germany. Methods: 288 pati ents suffering from occlusions of the lower limb arteries were subject ed to 336 treatments performed with a permanently controlled technique . In a short pilot study 10mg rt-PA/h were administered for 5 h but in the majority of the cases only 2.5mg/h were administered for a maximu m of 5 h. The average total dose of rt-PA was 2.97mg and the average t ime for lysis was 78 min. Results: 43 (84.3%) out of 51 embolic occlus ions and 168 (71.5%) out of 235 thrombotic occlusions were recanalised with a cumulative patency of 95% and 79.7% respectively after 2 years . One systemic bleeding occurred in the pilot study with 10mg rt-PA/h whereas with the 2.5mg/h dosage no systemic bleeding or embolism occur red in the 315 treatments. There were no deaths during hospitalisation . Six major and two forefoot amputations were necessary. Thirteen pati ents required a bypass operation and one an embolectomy. The advantage s of pur controlled technique are: short duration of treatment, small doses of activating agent an accurately directed pathway with the poss ibility of dilating stenoses during the same session, no danger of sys temic bleeding or embolism and, therefore, good prospects of success w ith minimal risk. Conclusion: The use of rt-PA for local lysis substit utes the inadequate tissue activator available for effective spontaneo us lysis and is, therefore, almost physiological. The effect of a very low nose of rt-EA was as good as that of higher doses.