CATHETER-DIRECTED UROKINASE THROMBOLYSIS - AN ADJUNCT TO PTA SURGERY FOR MANAGEMENT OF LOWER-EXTREMITY THROMBOEMBOLIC DISEASE

Catheter-directed thrombolysis was used either alone or as an adjunct to percutaneous transluminal angioplasty (PTA) or surgery for peripher al vascular occlusion on 112 occasions in 102 patients. Symptom durati on ranged from < one to > twenty-eight days. Thrombolytic therapy usin g urokinase plasminogen activator thrombolysis (uPAT), including intra thrombic injection when possible, was successful (> 50% lysis) in 99 p rocedures (88%). Technical failure (< 50% lysis) occurred in 13 proced ures (12%). In 9 of the 13 failures, intrathrombic injection of urokin ase was not possible, but the duration of occlusion was > twenty-eight days in all but 1. Two other failures were from embolic sources and 2 more occurred in patients with a hypercoagulable state. The uPAT was adjunctive to PTA/surgery in 56 cases (50%). PTA following uPAT was re quired and successfully performed in 24 of 27 cases (88.9%). Surgery f ollowed lytic therapy in another 32 (including the 3 failed PTAs). In the remaining 56 cases (50%), no additional intervention was required. There were 20 complications (18%), minor in 16 of 20 (80%). Minor com plications included small puncture site hematomas and distal embolizat ion resolved by continued lytic therapy. Four major complications occu rred. One was retroperitoneal hemorrhage directly contributing to the only death in the series. The other 3 were hematuria (2) and femoral n europathy (1). The authors conclude that catheter-directed lytic thera py alone or as an adjunct to PTA/surgery is a valuable approach to per ipheral vascular thromboembolic disease. It is less likely to succeed in chronic occlusion. The incidence of complications is moderate but a cceptable.