THROMBOLYSIS VERSUS SURGERY AS THE INITIAL MANAGEMENT FOR NATIVE ARTERY-OCCLUSION - EFFICACY, SAFETY, AND COST

Background. A controversy has evolved as to which therapy, thrombolysi s or thromboembolectomy, represents the optimal initial treatment for acute native artery occulsion. Methods. Forty-eight cases of acute cla ss I or II limb ischemia caused by native artery occlusion were retros pectively analyzed between 1988 and 1993. Nineteen of the patients wer e initially treated with thrombolysis (group 1), and 29 underwent thro mboembolectomy (group 2). Results. Initial clinical improvement was se en in 11 (57.9%) of 19 extremities in group 1, with complete clot reso lution in 21%, partial lysis in 47.4%, and no angiographic improvement in 31.6%. Significantly superior results were achieved in group 2; 28 (97%) of 29 limbs showed clinical improvement after initial surgical therapy (p = 0.001). Limb salvage was 88.2% in group 1 and 96.6% in gr oup 2 (p = 0.5). Adjunctive procedures for limb salvage were necessary in 10 (52.6%) of 19 limbs in group 1 compared with only five (17.2%) of 29 limbs in group 2 (p = 0.013). Perioperative mortality was 10.5% and 10.3% (p = 1.0), whereas major postoperative complications occurre d in 63.2% and 37% of patients in groups 1 and 2, respectively (p = 0. 14). Hospital and professional patient charges were analyzed for the 1 2 most recent patients from each group. Total mean charges per patient were higher in group 1 ($45,171) than in group 2 ($24,898) (p = 0.046 ). Conclusions. Patients initially treated surgically achieved better immediate clinical results with significant cost savings and without s ignificant differences in morbidity, mortality, or limb salvage compar ed with patients treated initially by thrombolysis.