rt-PA thrombolysis in acute thromboembolic upper-extremity arterial occlusion

Purpose: Retrospective analysis of the results of rt-PA thrombolysis in the treatment of acute thromboembolic occlusion of the upper limb. Methods: Of 55 patients with demonstrated acute embolic arterial occlusion, rt-PA thrombolysis was performed on 40 occlusions in 38 patients (23 women with a mean age of 62 years, range 32-85 years; 15 men with a mean age of 65 years, range 32-92 years) according to the following design: 6 mg rt-PA/ hr for 30 min, 3 mg rt-PA/hr for the next 30 min, 1 mg rt-PA/hr for 7 hr, a nd 0.4 mg rt-PA/hr until the end of lysis. Onset of symptoms varied from 1 to 14 days. Included were three isolated upper-arm occlusions, nine combine d brachial and forearm occlusions, and 28 forearm and hand artery occlusion s. Results: The overall success rate was 55%. The lysis results for isolated u pper arm, combined brachial and forearm occlusions, and forearm and hand ar tery occlusions were 100%, 66%, and 46%, respectively. In eight patients su rgical embolectomy had to be performed after failed thrombolysis No amputat ion was required in the follow-up period. No lethal complications occurred. Conclusions: Interventional rt-PA treatment of proximal upper-extremity art erial occlusions may be performed with comparable success rates to surgical embolectomy and without severe complications. For distal occlusions the re sults are inferior to the success rates obtained with surgery.