Intraoperative streptokinase: A useful adjunct to balloon-catheter embolectomy

Abstract

Intraoperative thrombolysis was attempted in 31 acutely ischaemic legs after operative arteriography had demonstrated residual distal thrombus or occlusion following balloon-catheter thromboembolectomy. There were 30 patients, 16 men and 14 women, aged 43-82 (median 73) years. The indication for operation was severe ischaemia with sensorimotor loss in 25 limbs, failed percutaneous thrombolysis in three and acute graft occlusion in three. A total of 21 perfemoral, 11 perpopliteal and four graft embolectomies were initially performed. Following arteriography, 100,000 units streptokinase was infused down the isolated distal arterial tree over 30 min and arteriography repeated. Complete lysis was achieved in 11 legs (35 per cent) and partial lysis in 12 (39 per cent). Additional procedures required included six operative angioplasties and six bypass grafts. After operation pedal pulses were restored in 14 limbs (45 per cent), with a viable leg in 23 cases (74 per cent) at the time of patient discharge or death. There were five wound haematomas but no evidence of systemic fibrinolysis. Four amputations were required, none in the group undergoing successful lysis, and there were seven deaths, five from cardiac disease. Arteriography after balloon-catheter embolectomy is essential to detect residual thromboembolus and intraoperative streptokinase appears to be a safe and effective way of removing this.

The Role of Hybrid Procedures in the Management of Peripheral Vascular Disease

“…In the study by Beard et al intraoperative thrombolysis was attempted in 31 acutely ischemic legs after operative arteriography. Complete lysis was achieved in 11 cases (35%) and partial lysis in 12 (39%) (31). The aim of the study by Witz et al (32) was to evaluate the use of intraoperative intra-arterial urokinase infusion after thromboembolectomy in 21 patients with acute lower limb ischemia.…”

Acute Limb Ischemia Secondary to Catastrophic Massive Intracardiac Thrombus in Patient with Mitral Stenosis: A Case Report and Mini Literature Review

“…Another possibility is to inject an intraoperative thrombolytic agent directly into the associated artery in order to dissolve any remaining thrombus. [38][39][40] Ischemia of Ruhterford class III is presumed to be a permanent state. Along with audible vessel Doppler pulse examination, the patient had severe sensory and motor loss, along with muscle rigidity and persistent skin discoloration.…”

Microtibial embolectomy

“…Beard et al 10 described the use of adjunctive thrombolysis from the popliteal route after unsuccessful popliteal embolectomy in 14 tibial occlusions using 100 000 u of streptokinase. However, those with ``trash foot'' did poorly with this technique and the limb salvage rate quoted of 75% was the overall figure for the series of 31, which included 17 limbs with acute occlusion of the femoro-popliteal segment only.…”