T. Hoelting et al., THE VALUE OF PREOPERATIVE LYTIC THERAPY IN LIMB-THREATENING ACUTE-ISCHEMIA FROM POPLITEAL ARTERY ANEURYSM, The American journal of surgery, 168(3), 1994, pp. 227-231
In a retrospective study, we analyzed our experiences in 24 patients w
ith acute ischemia from popliteal artery aneurysms over a period of 27
years and evaluated the value of a preoperative lyric therapy as an a
djunct to surgical revascularization, compared to surgery alone. Preop
erative urokinase therapy revealed a satisfactory improvement of the r
unoff in all cases. Follow-up angiography showed complete lysis in 6 a
nd incomplete lysis in 3 of 9 patients. In contrast, hi patients treat
ed by surgery alone, postoperative angiography showed residual clots i
n all cases. The overall amputation rate was 25% (6/24) in 24 poplitea
l aneurysms with acute ischemia, including four patients,vith primary
amputation for irreversible gangrene. Bypass grafting alone resulted i
n an early amputation rate of 9% (1/11) and occlusive complications of
45% (5/11) compared to no limb loss and no bypass complication in pat
ients who underwent combined surgery and preoperative lysis (0/9). Our
results underline the value of preoperative lytic therapy as an impor
tant factor in the management of acute ischemia in popliteal artery an
eurysms.