PERCUTANEOUS INTRAARTERIAL THROMBOLYSIS - ANALYSIS OF FACTORS AFFECTING OUTCOME

PURPOSE: The authors report results of high-dose thrombolytic therapy in native arteries and vein grafts and discuss the various factors aff ecting outcome. PATIENTS AND METHODS: In a retrospective study, the ou tcome of 82 high-dose urokinase infusions in 76 patients was examined. Comorbid risk factors as they relate to outcome were studied extensiv ely with log-linear analysis. Positive thrombolytic outcome (PTO) is d efined as complete thrombolysis of a previously occluded segment with restoration of antegrade flow augmented by angioplasty or operative in tervention to clear symptoms for 30 days. RESULTS: The procedure resul ted in a PTO in 63 of 82 instances (77%). The treatment was with uroki nase alone in 39 cases (47%) and urokinase followed by surgery in 34 ( 41%), by angioplasty in four (5%), and by angioplasty in the proximal artery and peripheral vein grafting in five (6%). All stenoses associa ted with grafts were treated surgically. None of the following affecte d thrombolytic outcome: age of occlusion, heparin dose, catheter type, length or location of graft, or artery versus graft occlusion. The 30 -day mortality was 6.1%, with a procedure-related mortality rate of 2. 4%. Overall amputation rate was 18% (74% for patients in whom lysis fa iled by 30 days). CONCLUSION: The presence of at least one runoff vess el was the most important factor affecting outcome (PTO, 95%; P = .000 01, chi2). The most important comorbid risk factor for failed thrombol ysis was coronary artery disease (P = .03, chi2).