Comparison of thrombolytic therapy of lower-extremity acute, subacute, and chronic arterial occlusions

• Published in: Catheterization and cardiovascular diagnosis 1998-06, Vol.44 (2), p.159-169
• Main Authors: Wholey, Michael H., Maynar, Manuel A., Wholey, Mark H., Pulido-Duque, Juan M., Reyes, Ricardo, Jarmolowski, Chester R., Castaneda, Wilfrido R.
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Angiography; Angioplasty; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - drug therapy; Arterial Occlusive Diseases - surgery; arteries; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Chronic Disease; Endarterectomy; extremities; Female; Follow-Up Studies; Humans; Infusions, Intra-Arterial; Leg - blood supply; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Plasminogen Activators - administration & dosage; Retrospective Studies; Stents; Thrombectomy; thrombolysis; Thrombolytic Therapy; transluminal angioplasty; Treatment Outcome; urokinase; Urokinase-Type Plasminogen Activator - administration & dosage
• ISSN: 0098-6569; 1097-0304
• DOI: 10.1002/(SICI)1097-0304(199806)44:2<159::AID-CCD8>3.0.CO;2-5

Our purpose was to study the effectiveness of thrombolytic therapy in treating acute, subacute, and chronic arterial occlusions in a multicenter retrospective study. Intraarterial urokinase infusion was performed in 235 patients for occluded native arteries. There were 70 (30%) with acute and 26 (5%) with subacute occlusions, and 141 (59%) with chronic symptoms for longer than 3 mo. Complete thrombolysis was achieved in 60 (86%) of the acute, 20 (77%) of the subacute, and 106 (75%) of the chronic occlusions. Adjunctive interventional procedures were performed as needed. Long‐term follow‐up revealed a primary patency of 87%, 85%, and 76% for the acute, subacute, and chronic occlusion groups, respectively. We conclude that the rate of complete thrombolysis of chronic occlusions proved slightly more efficient for acute and virtually the same for subacute occlusions. Long‐term follow‐up demonstrated a higher failure rate with chronic than with acute occlusions, probably due to worsened peripheral vascular runoff. Cathet. Cardiovasc. Diagn. 44:159–169, 1998. © 1998 Wiley‐Liss, Inc.