Thrombolytic therapy in ischemic limbs: Is it a worthwhile therapeutic option?

Abstract

Theoretically thrombolysis provides an attractive option in the therapy of the acutely ischemic limb. This is particularly so since thrombosis on the background of arteriosclerotic disease has become the common presenting cause, whereas previously the main cause was embolic disease. This consideration also applies to the acutely occluded peripheral vascular graft. Eighty-four patients who were treated with urokinase during a 24-month period were studied retrospectively. Thrombosis was the cause of occlusion in 68 patients (80.9%), and embolus was the cause in 16 (19.0%). In 17 patients (20.2%) there was occlusion of a bypass graft, and in 67 patients (79.7%) there was occlusion of the native artery. We also studied the effect of thrombolysis with acute occlusion in 25 patients who were diabetic. The time from onset of symptoms to beginning of treatment was also considered. We believe that thrombolysis should have a place in the treatment of the acutely occluded limb, but the physician should be aware of the potential complications of thrombolytics, particularly hemorrhage. Furthermore, an adequate infrastructure should be in place consisting of properly trained nursing staff and an angiography facility providing service on a 24-hour basis.