LOCAL INTRAARTERIAL THROMBOLYSIS WITH UROKINASE COMBINED WITH BALLOONANGIOPLASTY IN THE LOWER-EXTREMITIES

Objective: To assess the effect of thrombolysis with urokinase in the treatment of acute and subacute arterial thrombosis or graft occlusion . Design: Open study. Setting: County hospital, Sweden. Subjects: 20 s elected patients with lower limb arterial or graft occlusions of less than six months' duration, 17 of wham presented with rest pain (four w ith ulceration) and the rest with claudication. Interventions: High do se urokinase (4000 IU/minute for up to 8 hours) given intra-arterially , followed by oral anticoagulation for 6 months. Main outcome measures : Patency at one month and one year, morbidity and mortality. Results: At one month 6/17 who presented with rest pain could walk unlimited d istances, 8 had claudication between 50 and 500 m, and 3 had no improv ement; 2 had had below knee amputations. At one year only 4 could walk unlimited distances, 5 had claudication between 50 and 500 m, 2 had r est pain, 4 had had major amputations, and 1 was dead and 1 was lost t o follow up. Five patients had had 10 additional procedures. Of the 3 who presented with claudication, 2 improved their walking distance to at least 100 m, and one had total relief of symptoms after one month; after a year one had no symptoms, one had mild claudication, and one h ad severe claudication (120 m). Three developed complications: one ble eding 12 hours after treatment was successfully treated by transfusion , one embolism to the midpopliteal artery was successfully treated by embolectomy, and one episode of bleeding during lysis ceased when trea tment was stopped.Conclusion: Thrombolysis is at best only an adjunct to balloon angioplasty or traditional vascular operations.