E. Pilger et al., THROMBOLYTIC TREATMENT AND BALLOON ANGIOPLASTY IN CHRONIC OCCLUSION OF THE AORTIC BIFURCATION, Annals of internal medicine, 120(1), 1994, pp. 40-44
Objective: To evaluate nonsurgical alternatives in reopening chronical
ly occluded aortic bifurcation. Design: Uncontrolled randomized study.
Setting: University-affiliated referral center for vascular diseases.
Patients: Twenty-five of 39 consecutive patients with chronic aortoil
iac disease including a totally occluded aortic bifurcation were found
to be acceptable candidates for an aortobifemoral prosthetic graft. I
ntervention: Patients were randomly assigned to receive either strepto
kinase or urokinase or recombinant tissue-type plasminogen activator (
rt-PA). In cases of successful thrombolysis and residual obstructions,
subsequent balloon angioplasty was attempted. Prosthetic bypass graft
ing was done if thrombolytic treatment and balloon angioplasty failed.
Results: Complete lysis was achieved in 5 of 25 patients (20%). In 10
(40%) patients, lysis showed residual obstructions, which were reopen
ed mechanically in 8 patients; 2 patients had extra-anatomical bypass
grafts. Ten patients (40%) without thrombolysis had surgical aortobife
moral bypass grafts. Overall, recanalization and clinical improvement
were achieved in 13 of 25 patients (52%) by thrombolytic therapy and s
ubsequent balloon angioplasty. The recanalization rate did not differ
among the different thrombolytic drugs. However, rt-PA therapy resulte
d in reopening after 4 days of treatment; streptokinase, after 6 days;
and urokinase, after 9 days (P < 0.005). No major complications or de
aths occurred. Conclusion: Thrombolytic treatment followed by balloon
angioplasty may help avoid the need for aortobifemoral prosthetic bypa
ss grafting in more than 50% of patients with chronic aortoiliac disea
se.