THE VALUE OF PREOPERATIVE LYTIC THERAPY IN LIMB-THREATENING ACUTE-ISCHEMIA FROM POPLITEAL ARTERY ANEURYSM

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.