Low-dose intra-arterial streptokinase infusion therapy of peripheral arterial occlusions and occluded vein grafts.

To study the effectiveness of low-dose thrombolytic therapy the authors report their experience with local, low-dose, intra-arterial streptokinase infused at a rate of 5000 units/h in four patients with occluded vein grafts and eight with peripheral arterial occlusions presenting with limb-threatening ischemia. The patients had had symptoms for 4 hours to 6 weeks. The streptokinase infusion successfully declotted two occluded vein grafts and restored distal blood flow in five patients with peripheral arterial occlusion. Complications resulting in early withdrawal of thrombolytic therapy included surgical wound hematomas in two patients. Two patients had severe bleeding at the arterial puncture site leading to the death of one of them. Treatment after cessation of thrombolytic therapy included femoropopliteal bypass in three patients, percutaneous transluminal balloon dilatation of a stenotic popliteal artery in one patient and thromboembolectomy in three patients. Two patients required below-knee amputation because of irreversible ischemia. The authors conclude that in carefully selected patients, intra-arterial infusion of streptokinase locally in low dosage is an important adjunct in the treatment of limb-threatening ischemia caused by occluded vein grafts and acute arterial thrombosis. They warn that selective thrombolytic therapy with streptokinase must be used with caution since it may be associated with serious complications.