Colour duplex sonography-guided local lysis of occlusions in the femoro-popliteal region

Background. To evaluate colour duplex sonographic guidance of local lysis o f occlusions in the femoropopliteal region. Methods. Thirteen consecutive patients (8 female, mean age 67) with periphe ral artery disease with acute and subacute occlusions in the superficial fe moral or popliteal artery were included in this study. The lesions were ide ntified by colour duplex ultrasound (Acuson 128 XP/10) After anterograde pu ncture the guidewire was advanced through the arterial lesions under B-mode image control. The Mewissen Infusion Catheter and a Katzen infusion wire w ere then accurately positioned within the lesion under B-mode image control . The fibrinolytic drugs were then inserted into the occlusions, initially 2.5 mg rt-PA as a bolus followed by Urokinase (50.000 IU/h) for 24 hours. A fter control duplex sonography (over 24 hours) the additional angioplasty w as performed either under fluoroscopic or exclusively under ultrasound guid ance. Results. Eleven of 13 patients with occlusions in the femoro-popliteal regi on were partially recanalised after ultrasound guided local lysis and after the additional angioplasties (nine under fluoroscopic and three under ultr asound guidance) the arteries were completely recanalised. Conclusions. Our data show that not only is the positioning of the catheter and the guidewire for local lysis exclusively under colour duplex guidance possible, but also the surveillance of the local lysis and the additional angioplasty. In the case of any complications, however, easy access to angi ography should be possible.