MACROEMBOLISM AS A COMPLICATION OF SYSTEM IC THROMBOLYTIC THERAPY OF AN OCCLUSION OF AN AORTOBIFEMORAL GRAFT WITH ULTRAHIGH DOSE UROKINASE

The case of a 70-year-old woman suffering from a long occlusion of the right branch of an aortobifemoral dacrongraft implanted six years ago is reported. Patency could be achieved by a systemic application of a n ultrahigh dose of urokinase (UHUK = 9000000 I.U/6 h, intermittent da ily application, two cycles). As a major complication macroembolism to the popliteal artery and to the superficial femoral artery occurred, however. A further cycle of UHUK, local thrombolytic therapy (12 mg rt PA) and surgical thrombectomy failed to achieve persistent recanalizat ion. So the patient finally had to be provided with a femorocrural com posite bypass. In conclusion, in a systemic thrombolytic therapy of oc clusions of dacron grafts in the aorto-iliacal area a standard dose of urokinase (initial dose 600000 I.U., maintenance dose 150000 I.U./h, infusion pump) is recommended.