INTRAARTERIAL INFUSION OF UROKINASE FOR ACUTE, CRITICAL ISCHEMIA IN THE LOWER-LIMB

OBJECTIVE: To assess the value of intra-arterial urokinase infusion in the management-of acute, critical ischemia of the lower limb. DESIGN: A prospective study. SETTING: A vascular surgery department within a university hospital. PATIENTS: Twenty-five consecutive patients with a cute, critical ischemia of the lower limb, excluding those requiring i mmediate surgical intervention. Follow-up ranged from 1 to 18 months. INTERVENTION: Angiography followed by intra-arterial infusion of uroki nase. MAIN OUTCOME MEASURES: Angiographic and clinical evidence of clo t lysis and limb reperfusion, any surgical procedures required and fin al clinical outcome. RESULTS: Urokinase was technically successful in lysing clot in 19 patients: 7 required no further treatment; in 8 an u nderlying lesion was identified and repaired by either percutaneous an gioplasty or surgery; in the remaining 4 patients, although the clot w as lysed, the limbs remained ischemic and, since reconstruction was co nsidered impossible, amputation was required. Two patients improved cl inically with little angiographic evidence of clot lysis. A total of n ine patients required amputation, seven of these as a ''primary'' proc edure after urokinase infusion. There were four episodes of significan t morbidity but no deaths. CONCLUSION: Urokinase has a place in the ma nagement of acute vascular occlusion of the lower limb, not only in tr eating the occlusion but, equally importantly, in facilitating identif ication of lesions that require surgical intervention.