Local intra-arterial thrombolysis with urokinase combined with balloon angioplasty in the lower extremities.

OBJECTIVE: To assess the effect of thrombolysis with urokinase in the treatment of acute and subacute arterial thrombosis or graft occlusion.

DESIGN: Open study.

SETTING: County hospital, Sweden.

SUBJECTS: 20 selected patients with lower limb arterial or graft occlusions of less than six months' duration, 17 of whom presented with rest pain (four with ulceration) and the rest with claudication.

INTERVENTIONS: High dose urokinase (4,000 IU/minute for up to 8 hours) given intra-arterially, followed by oral anticoagulation for 6 months.

MAIN OUTCOME MEASURES: Patency at one month and one year, morbidity and mortality.

RESULTS: At one month 6/17 who presented with rest pain could walk unlimited distances, 8 had claudication between 50 and 500 m, and 3 had no improvement; 2 had had below knee amputations. At one year only 4 could walk unlimited distances, 5 had claudication between 50 and 500 m, 2 had rest pain, 4 had had major amputations, and 1 was dead and 1 was lost to follow up. Five patients had had 10 additional procedures. Of the 3 who presented with claudication, 2 improved their walking distance to at least 100 m, and one had total relief of symptoms after one month; after a year one had no symptoms, one had mild claudication, and one had severe claudication (120 m). Three developed complications: one bleeding 12 hours after treatment was successfully treated by transfusion, one embolism to the midpopliteal artery was successfully treated by embolectomy, and one episode of bleeding during lysis ceased when treatment was stopped.

CONCLUSION: Thrombolysis is at best only an adjunct to balloon angioplasty or traditional vascular operations.