THROMBOLYTIC THERAPY IN PERIPHERAL ARTERIAL OCCLUSIVE DISEASE - MECHANISMS OF ACTION AND DRUGS AVAILABLE

Catheter-directed thrombolytic therapy has become an important part of the treatment of patients with acute arterial and graft occlusion. Th e underlying pharmacologic principle is the activation of plasminogen, bound to fibrin within the thrombus. Guide-wire passage reliably pred icts success of catheter-directed thrombolysis. The underlying disease process leading to thrombosis should be accurately identified and pro mptly corrected to reduce the probability of recurrent occlusion. Stre ptokinase (SK), urokinase (UK) and recombinant tissue plasminogen acti vator (rt-PA) are the three agents used to treat peripheral arterial o cclusive disease. The evolution from SK to UK and rt-PA and improvemen ts in techniques and delivery systems have led to improved success rat es and lower complication rates. Patient selection, basic technical co nsiderations and overall results are discussed here. The currently ava ilable thrombolytic agents, as well as those being developed, are revi ewed to provide background information for current and future applicat ions.