Long-term results after percutaneous low-dose streptokinase treatment for acute arterial thrombosis

The objective of this study was to evaluate the immediate efficacy and long -term results of a standard protocol of percutaneous, low dose, intraarteri al streptokinase treatment in acute arterial thrombosis. This involved anal ysis of 48 consecutive patients with acute peripheral arterial thrombosis, treated with thrombolysis between October 1988 and August 1997. There were 30 men and 18 women patients, with an average age of 66.5 years. There was thrombosis of the native artery in 32, thrombosis of an aneurysm in seven, and graft occlusion in nine. After the occlusion was defined by arteriograp hy, the low-dose streptokinase (10,000 units per hour) was continuously inf used into the thrombosed segment following a bolus injection of 10,000 unit s. The initial success rate (defined as partial or complete lysis) was 79.6 %. Additional therapy after lysis consisted of percutaneous transluminal an gioplasty in 18, bypass surgery in six, anticoagulant therapy in seven, and amputation in seven owing to irreversible ischemic damage. One patient die d of myocardial infarction before additional therapy. Of the 20.4% failures to fibrinolysis, two patients received bypass surgery, two surgical thromb ectomy, three sympathectomy, and three had amputations. Local bleeding comp lications were seen in five (10%) patients. Only one patient needed surgica l exploration. Allergic reaction to streptokinase was seen in five patients (10%) and fibrinolytic therapy was continued with urokinase in three. In t he follow-up (1-107 months) eight patients died and three amputations were performed after a mean time of 17 months after thrombolysis owing to progre ssion of arteriosclerosis. This resulted in a limb salvage rate of 76% afte r 1 year and 65% after 5 years (Kaplan-Meier). Low-dose, local, intraarterial streptokinase therapy is an effective prelim inary step in management of acute arterial thrombosis. Especially with adeq uate additional treatment, it is possible to achieve satisfactory long-term patency rates.