Low-dose direct fibrinolysis in peripheral vascular disease

Abstract

One hundred thirty patients underwent low-dose, catheter-directed fibrinolytic therapy for arterial and graft occlusions present for various periods of time. In 65 consecutive patients the therapeutic parameters were identical, and a careful hematologic evaluation was performed. In the subsequent 65 patients, varying doses of fibrinolytic agents were employed. Fibrinolytic therapy was found to be beneficial in a diverse group of clinical situations and in patients whose occlusions had occurred at varying lengths of time. Early study demonstrated that effective fibrinolysis can be achieved at approximately onetwentieth of the systemic level and that systemic effects could be avoided in all patients during 24-hour infusions and in many patients infused up to 96 hours. Bleeding complications occurred only in patients in whom concomitant heparinization was employed, and this was thought to be the causative factor. Therapeutic success and avoiding complications are strongly dependent on close monitoring of patients and joint decision making by the vascular surgeon and radiologist.

Intra-arterial Fibrinolytic Therapy

“…In successful cases, the major roentgenographic lytic effect occurred during the first 24 hours in 85% of patients, but 62% of patients showed additional lysis when infusion was continued beyond this point. 5 Although we studied a relatively small number of pa¬ tients, the 100% success rate in ten infusions with urokinase has been very encouraging. COMMENT Low-dose, intra-arterial, fibrinolytic therapy for throm¬ boembolic disease was introduced in 1974 in an attempt to concentrate thrombolytic effect while at the same time decreasing hemorrhagic and other systemic complications of intravenous infusions.1 The initial and widest experience has been with intra-arterial streptokinase.2"6 More recently, improved results and decreased complications have been reported with intra-arterial urokinase.…”

Plasma fibrinogen level as a potential predictor of hemorrhagic complications after catheter-directed thrombolysis for peripheral arterial occlusions

“…May 2017 57 Fiessinger, 1975 58 Fiessinger, 1976 59 Fiessinger, 1977 60 Fiessinger, 1981 61 Fletcher, 1986 62 * Flora, 1970 63 * Forbes, 1976 64 Gaffney, 1984 65 * Gardiner, 1986 66 Gardiner, 1989 67 Goodman, 1993 68 * Graor, 1984 69 Graor, 1985 70 Graor, 1986 71 Graor, 1986 72 Graor, 1988 73 Graor, 1990 74 Gurll, 1976 75 Hallett, 1983 76 Han, 2010 77 Hargrove, 1982 78 Hargrove, 1982 79 Hess, 1982 80 Hess, 1987 81 Hess, 1996 82 Holden, 1990 83 * Huettl, 1995 84 Jorgensen, 1991 85 * Kakkasseril, 1985 86 Katzen, 1981 87 Katzen, 1984 88 Koltun, 1987 89 Kroger, 2000 90 Krupski, 1989 91 Kuss, 2003 92 * Kwaan, 1973 93 * Lammer, 1985 94 Lammer, 1986 95 Law, 1994 96 LeBlang, 1992 97 LeVeen, 1972 98 Lonsdale, 1992 99 Lonsdale, 1993 100 Lucey, 1983 101 * Magnan, 1994 102 Maksimenko, 1999 103 * Marbet, 1982 104 Marder, 1967 105 *…”