Thrombolysis of peripheral arterial and graft occlusions: improved results using high-dose urokinase

Abstract

Ninety-three thromboembolic occlusions of peripheral arteries or grafts in 85 patients John R. Fischer1were treated with high-dose urokinase by direct intraarterial infusion. Urokinase was infused at 4000 lU/mm until antegrade blood flow was reestablished and then at 1000 or 2000 lU/mm until clot lysis was completed. Of the 93 infusions, 75 (81%) resulted in clinical improvement. The infusion therapy was incomplete in nine patients. The mean duration of the 84 completed infusions was 18 ± 20 hr, the incidence of complete clot lysis was 83%, and the incidence of clinical improvement was 89%. Significant bleeding, requiring transfusion, occurred during or after four of the urokinase infusions (4%).

Thrombolysis during the endovascular treatment of iliac artery occlusions

“…By using thrombolysis, very high rates of primary recanalization have been reported (98%) (9,16,17). We used multi-side hole catheters due to better and uniform sprinkling of the thrombus by the drug (9,11,16). We used urokinase because it achieves better results with fewer complications than other drugs (9,11,16).…”

“…We used multi-side hole catheters due to better and uniform sprinkling of the thrombus by the drug (9,11,16). We used urokinase because it achieves better results with fewer complications than other drugs (9,11,16). Thanks to our experience, we managed to go directly through the iliac occlusion with a guidewire without any mistakes on our part in 84% of cases: in one case we suspended the procedure because of coagulation issues, and in three cases (12%), we suspended the treatment because of a subintimal progression of the guidewire.…”

“…The results of our experience seem to confirm that both the immediate complications and the long-term patency of the iliac occlusions treated with thrombolysis and PTA plus stenting may substantially overlap the ones reported in the literature covering simple stenose. We used the femoral approach because it is associated with fewer complications and because it is easier than other approaches (9,11,16). Endovascular treatment, moreover, preserves the vascular bed and does not interfere with possible subsequent surgery.…”

“…The pattern of treatment with a thrombolytic we used was modified slightly from that proposed by McNamara and Fisher (11). We administered uPA (Abbott Labs, Abbott Park, Illinois, USA) via 4 F intra-arterial catheter diluting 500,000 IU of uPA into 500 mL of physiologic solution (to obtain a concentration of 1,000 IU/mL), according to the following scheme: an initial load of 200 mL in the first hour (equivalent to 200,000 IU uPA, equivalent to 3,333 IU/min); subsequent infusion with 60 mL/hour (equivalent to 60,000 IU, equivalent to 1,000 IU/min), for a maximum period of 48-72 hours.…”

“…From a technical point of view, we monitored the hematocrit, prothrombin time, aPTT, fibrinogen, and fibrin degradation products (10,11). These examinations were performed just before beginning treatment, every 4 hours until we obtained an optimum heparin dosage, and subsequently every 8 hours until the heparin administration ended.…”