COMPARISON OF THROMBOLYTIC THERAPY OF LOWER-EXTREMITY ACUTE, SUBACUTE, AND CHRONIC ARTERIAL OCCLUSIONS

Our purpose was to study the effectiveness of thrombolytic therapy in treating acute, subacute, and chronic arterial occlusions in a multice nter retrospective study. Intraarterial urokinase infusion was perform ed in 235 patients for occluded native arteries. There were 70 (30%) w ith acute and 26 (5%) with subacute occlusions, and 141 (59%) with chr onic symptoms for longer than 3 mo, Complete thrombolysis was achieved in 60 (86%) of the acute, 20 (77%) of the subacute, and 106 (75%) of the chronic occlusions. Adjunctive interventional procedures were perf ormed as needed. Long-term follow-up revealed a primary patency of 87% , 85%, and 76% for the acute, subacute, and chronic occlusion groups, respectively. We conclude that the rate of complete thrombolysis of ch ronic occlusions proved slightly more efficient for acute and virtuall y the same for subacute occlusions. Long-term follow-up demonstrated a higher failure rate with chronic than with acute occlusions, probably due to worsened peripheral vascular runoff. (C) 1998 Wiley-Liss, Inc.