REGIONAL HYPERTHERMIC PERFUSION WITH FIBR INOLYTIC AGENTS AS THE LASTRESORT IN THE CRITICAL ISCHEMIA OF THE LOWER-EXTREMITIES

In 19 patients (male-female: ratio 10:9; median age 67.1 (42-90) years ) with a critical ischaemia of the lower extremities either after fail ed attempt of revascularization (n=4) or because of lacking possibilit y for vessel reconstruction measures (n=16) a regional extremity perfu sion with a fibrinolytic agent has been performed using a heart lung m achine. In one patient both lower extremities were treated. In the fir st 30 minutes of the total 60 minutes perfusion time on average 31 mg (20-50 mg) of recombinant tissue-plasminogen activator (Actilyse (R)) have been added to the perfusion solution. In order to enhance the fib rinolysis-activity the perfusion solution was warmed up to 40 degrees C. Systemic side effects have not been observed. Two patients died pos toperatively because of their underlying diseases (mesenteric artery e mbolism, myocardial infarction), two patients experienced postoperativ e haemorrhage and one patient had a wound infection. In 11 cases (55 % ) an opening of the stem-arteries has been reached. Seven of these wer e successfully revascularized with a femoro-crural bypass in a followi ng operation. Nine extremities (45 %) remained without opening of the stem-arteries, however, in four cases (20 %) an improved radiographic contrast of the collaterals has been reached. 11 (61%) of the followed -up extremities were successfully revascularized. Amputation has been performed in seven cases (39 %). The regional hyperthermic perfusion w ith fibrinolytic drugs enables a reopening of the stem-arteries and th e creation of accepting vessels for vascular procedures in primarly in operable arterial occlusions.