Fibrinolytic therapy for upper-extremity arterial occlusions.

Abstract

Acute upper-extremity arterial occlusion may be due to embolic phenomena or de novo thrombosis. If the occlusion is left untreated, claudication or ischemia necessitating amputation can occur. Operative Fogarty-balloon embolectomy has been the treatment of choice for this entity. In a 6-year period the authors used fibrinolysis on nine occasions in eight patients to treat acute upper-extremity arterial occlusions. Concomitant balloon angioplasty was helpful in four cases. Success, defined as a normal hand with at least one artery that was continuously patent to the wrist, was achieved in all patients. A single significant groin hematoma was seen. Neither stroke nor death occurred in any case, and no amputations were necessary. Local transcatheter intraarterial administration of urokinase can be considered a first-line treatment for brachial artery embolus and other causes of acute upper-extremity arterial occlusion.

Local thrombolytic infusion in arterial ischemia of the upper limb: Mid-term results

“…Due to the rich collateral circulation at the level of the hand, a clinically acceptable result may be reached despite the presence of residual clots after treatment. Associated PTA of an underlying stenosis was only rarely performed compared to lower limb arterial ischemia [20,27,29,33]. PTA was required in one patient only in our series.…”

Investigation of mass-transfer in occluded rat arteryIn Vivo

“…Moreover, effective dose of urokinase for thrombolysis in coronary and aortocoronary bypass is 2-3x 106 IU upon intravenous administration [2], 1.2-2.7x 106 IU using transthrombus technique [9], and 1.2-5.5 mln IU upon intra-arterial administration [11], indicating a similar time during which a thrombolytic agent reaches the thrombus irrespective of the distance between the site of administration and thrombus. Thus, clinical observations indicate an intense massexchange in blocked segment of artery.…”

Intra-arterial thrombolysis of acute hand ischaemia with or without microcatheter: preliminary experience and comparison with the literature

“…The most frequent causes of acute ischaemia of the distal extremities of the hand include distal arterial stenoses and occlusions (either thrombotic or embolic) due to atherosclerosis, trauma (sports or occupational activities with repeated microtraumas) [7][8][9], embolism (atrial fi bril- [1][2][3][4][5][6][7][8][9][10][11][12], oppure da introduzione accidentale intra-arteriosa di irritanti chimici (droghe) [13][14][15][16][17], da anomalie anatomiche (sindrome da intrappolamento) determinanti compressione ab estrinseco [7,8] [18] ed eventuale angiografi a digitale a sottrazione d'immagine (DSA). Generalmente l'eco-color Doppler è il primo esame da eseguirsi, in quanto rapido, non invasivo e facilmente ottenibile.…”