Evolving Strategies for Thrombolytic Therapy of Peripheral Vascular Occlusion

Abstract

Abbreviations: FDA Food and Drug Administration, PAO peripheral arterial occlusion, rt-PA recombinant tissue-type plasminogen activator, SK streptokinase, UK urokinase CHARLES Dotter first described a technique for regional infusion of fibrinolytic agents a quarter century ago. Since then, thrombolytic therapy has become an integral part of the management of patients with acute peripheral vascular occlusive disease in native arteries and bypass grafts, hemodialysis grafts, extremity veins, and other sites. For the last 15 years, urokinase (UK) has been the thrombolytic drug of choice in the United States because of its proven efficacy, excellent safety profile, and low cost compared to most other available agents. The recent removal of UK from the marketplace by the United States Food and Drug Administration (FDA) has caused widespread confusion among interventional radiologists faced with performing thrombolytic therapy with use of alternative thrombolytic drugs. The purpose of this article is to review the currently available fibrinolytic agents, explain the withdrawal of UK, examine the published experience with other fibrinolytic agents in peripheral vascular occlusions, and suggest a rational approach to thrombolytic treatment at the beginning of the new century.