Peripheral thrombolysis for acute-onset claudication

Background: The aim of this study was to determine the outcome of patients who presented with sudden onset of incapacitating claudication of less than 2 weeks' duration and who were treated with peripheral arterial thrombolys is, Methods: The database of the Thrombolysis Study Group was searched retrospe ctively for patients who received thrombolysis for acute-onset claudication . Some 108 patients (65 men, median age 69 (range 29-94)years) were treated with intra-arterial tissue plasminogen activator at 14 hospitals. The medi an duration of symptoms was 72 h (range from 2 h to 2 weeks). There were 52 graft and 56 native vessel arterial occlusions. Results: The immediate outcome of thrombolysis for native vessel arterial o cclusion was thrombus clearance in 50 patients (89 per cent) and failed lys is in six (11 per cent). Thirty-six patients (64 per cent) had a secondary radiological or surgical procedure carried out after lysis. After 30 days f our patients (7 per cent) had a major amputation, eight (14 per cent) had d ied, 38 (68 per cent) were symptom free and seven (12 per cent) continued t o have claudication, Three patients (5 per cent) suffered a major haemorrha ge. The immediate outcome of thrombolysis for graft occlusion was thrombus clearance in 48 patients (92 per cent) and failed lysis in four (8 per cent ); 27 patients (52 per cent) had a secondary procedure. After 30 days four patients (8 per cent) had a major amputation, seven (13 per cent) had died, 32 (62 per cent) mere symptom free and nine (17 per cent) had persistent c laudication. Three patients (6 per cent) suffered a major haemorrhage. Conclusion: Patients who presented with acute onset of incapacitating claud ication had an outcome similar to that after thrombolysis for critical isch aemia, It is recommended that patients who present in this way should be ob served and treated with thrombolysis only if they progress to critical isch aemia.