Long term results of systemic thrombolysis therapy in aorto-iliac occlusive disease

Background: Long term results of systemic lysis therapy with ultrahigh-dose urokinase (UHUK) in reopening aorto-iliac occlusive disease have not yet b een evaluated. This prospective trial investigates the long-term primary pa tency rate, the rate of complications and assesses the role of different ex pected influence parameters on the primary patency rate. Patients and methods: 72 patients with aorto-iliac occlusive disease receiv ed daily intravenous infusions of UHUK either until reperfusion or - after at least 3 cycles - no progress in recanalization could be stated on two co nsecutive days by duplex scanning Results: Systemic lysis therapy was morphological at least partially succes sful in 44 patients (61.1 %). Concomitant percutaneous transluminal angiopl asty was performed in 41 patients (56.9%), surgery in 7 patients (9.7%) and both in fin-ther 5 patients (6.9%). In patients without surgery hemodynami cal success could be achieved in 39 patients (54.2%) and even more importan t clinical success in 51 patients (70.8%). Compared to baseline results pat ients improved significantly in ankle/brachial pressure index and in Fontai ne stages (p < 0,001), the same results could be seen after a mean follow-u p period of 62 months. Thrombolysis was complicated in 4 patients (5.6%) ky macroembolizations but no major bleedings or deaths occurred. Primary pate ncy was 76%, 64%, and 43% after 1, 5 and 10 years. Male sex and distal loca lization were significantly, correlated with lower primary clinical patency . Conclusion: Systemic lysis therapy, is an alternative to surgical intervent ion in acute and subacute aorto-iliac occlusive disease, because it offers acceptable long-term results with a low rate of complications.