Local thrombolysis in the treatment of peripheral arterial vascular diseases

Abstract

While atherosclerosis develops in a progressive manner, acute arterial thrombosis and embolism are characterized by fulminant occlusion of vessels. Special localisation of atherosclerotic plaques might result in severe and life threatening clinical symptoms. Multidisciplinary consultations of angiologist, radiologist and surgeon are necessary to identify the most proper diagnosis, and urgent intervention should be taken which nowadays involves local thrombolysis, too. The essence of this method is a prolonged, intravenous infusion of tissue plasminogen activator administered locally into the thrombus via an intraarterial catheter. Revascularisation can be controlled by angiography. The authors present the indications and contraindications of local thrombolysis in peripheral arterial disease and also demonstrate two cases which support the importance of this question. Data of some recent publications are also discussed. This emphasizes that local thrombolysis is equivalent to surgical possibilities. In specific cases, with complex clinical situations this method might be the first choice of treatment. Finally the most important conclusions and future prospects are presented.