Acute arterial occlusions of the small vessels of the hand and forearm: Treatment with regional urokinase therapy

PURPOSE: Arterial occlusions of the small vessels of the forearm and hand m ay have the same consequences as arterial occlusions in the distal lower ex tremity, There is limited reported experience with the regional thrombolyti c therapy in this setting. The authors reviewed their experience with throm bolytic therapy in acute and subacute arterial occlusions of the distal upp er extremity to further clarify its role. MATERIALS AND METHODS: Twelve patients with acute or subacute arterial occl usions of the forearm and hand who had ischemic digits and were treated wit h regional urokinase infusion were identified retrospectively. Their medica l and radiology records were reviewed. RESULTS: All 12 patients demonstrated angiographic improvement and 11 patie nts demonstrated clinical improvement after treatment. Tissue necrosis in f our patients led to partial amputation of one digit in two patients and thr ee digits in two patients, Three of these patients had category III ischemi a at presentation, The level of resulting amputation was altered in all but one patient. Vasospasm was noted frequently but responded to vasodilators. No significant complications occurred. CONCLUSIONS: When therapeutic alternatives are limited to anticoagulation a nd expectant amputation, regional urokinase infusion can optimize distal ru noff, obviate or improve the options for distal surgical bypass, and limit tissue loss.