RECANALIZATION OF CHRONIC PERIPHERAL ARTERIAL OCCLUSIONS BY ALTERNATING INTRAARTERIAL RT-PA AND PGE(1)

Background: Recanalization of femoral artery occlusions is difficult a nd different forms of intra-arterial lysis or mechanical procedures ha ve been described. We investigated the effectiveness of a prolonged in tra-arterial lysis with rt-pa in combination with PGE(1) followed by a ngioplasty. Patients and Methods: 43 patients (age 60.4 +/- 14.3 years ) with peripheral arterial occlusions older than 3 months and longer t han 10 cm were treated with intra-arterial rt-pa (3 mg in 3 h) followe d by PGE(1) (2.1 ml/h for 3 h, concentration: 20 mu g/50 ml NaCl) in a lternating order. Treatment times ranged from 1 to 7 days (2.9 +/- 1.6 ). Doses of 26.5 +/- 21.9 mg rt-PA and 20.4 +/- 16 mu g PGE(1) were us ed. If necessary, angioplasty was performed after a wire was passed th rough the lumen. Results: Recanalization was achieved in 47 out of 85 arterial segments with reocclusion in 9 segments. The arterial perfusi on deteriorated once due to peripheral embolism. Other adverse effects included one case of retroperitoneal and one case of intracrural blee ding and one aneurysma spurium. Conclusion: In chronic arterial occlus ions which do not respond to conventional angioplasty and/or short ter m fibrinolysis recanalization may be achieved in about 50% by means of prolonged alternating application of rt-pa and PGE(1).