LONG-TERM RESULTS OF A SINGLE PROTOCOL FOR THROMBOLYSIS IN ACUTE LOWER-LIMB ISCHEMIA

In a prospective study, 78 of 157 patients with acute lower-limb ischa emia were considered suitable for thrombolysis. The immediate and 4-ye ar results of 52 patients managed by a single protocol are reported. O f 34 patients alive at 4 years, 23 had limb salvage. Initial treatment produced effective lysis in 38 patients (73 per cent) with significan t benefit in 35 (67 per cent); that benefit was sustained for a minimu m of 4 years in 30 patients (58 per cent). Seven of the 18 deaths by 4 years occurred within 30 days. Amputation was carried out in six pati ents within 30 days and in five during the next 4 years. Delayed amput ation followed persistent distal occlusion or progression of distal di sease. No death or amputation was caused by complication of treatment. In selected patients the risks of thrombolysis can be reduced to an a cceptable level by personal supervision and a strict protocol. In surv ivors, limb salvage is generally sustained for at least 4 years.