A REEVALUATION OF INTRAARTERIAL THROMBOLYTIC THERAPY FOR ACUTE LOWER-EXTREMITY ISCHEMIA

Purpose: This study was performed to clarify the role of intraarterial thrombolytic therapy (IATT) in the management of acute lower extremit y ischemia. Methods: A retrospective review of 77 patients undergoing 84 courses of high-dose regional urokinase IATT from July 1981 to June 1991 was performed. The group included patients with acute thrombosis of lower extremity bypass grafts (n = 48) or native arteries (n = 36) , presenting with ischemic but viable limbs, minimal or no motor dysfu nction, and an absence of muscle rigor or compartment syndrome. The da ta were then examined individually by site of thrombosis to evaluate p atient selection for IATT. Results: Complete lysis, complications (eit her distal thromboembolism or bleeding), and early limb loss occurred in 59.5%, 11%, and 6% of infusions, respectively. IATT precluded the n eed for operative intervention in 49% of acutely ischemic limbs. When surgery was required, successful IATT precisely localized responsible lesions and reduced the magnitude of operation. A subset of 13 patient s were identified in whom either no intrinsic abnormality or poor runo ff were evident after lysis and were treated with anticoagulation alon e. Conclusions: These data show IATT to be especially suitable for thr ombosis of native iliac or femoropopliteal arteries and infrainguinal vein grafts. IATT serves primarily as an adjunct in management of acut e lower extremity ischemia. After successful IATT, subsequent therapy can be tailored to the anatomic cause of thrombosis.