Intra-arterial segmental thrombolysis in patients with arterial embolism of cardiac origin.

OBJECTIVE

It is well known that in the evolution of cardiac diseases, thromboembolic accidents are quite frequent. In patients with acute peripheral ischaemia, surgical treatment is usually the procedure of choice, but in some circumstances some of these patients cannot benefit from the surgical treatment. Conservative treatment rarely leads to satisfactory results. An alternative of therapy is the thrombolysis, but administration of Streptokinase in systemic dose can lead to serious thromboembolic accidents and hemorrhage. Intra-arterial administration of the drug, in small doses, can eliminate this risk. The aim of this study was to demonstrate the efficacy of intra-arterial thrombolysis in patients with cardiac diseases complicated with peripheral arterial emboli.

METHOD: In the period 1984-1997, we performed a number of 84 intra-arterial thrombolyses. Sixty-one of them were performed in case of chronic or acute arterial obstruction of the inferior limbs, occurring in the evolution of chronic arterial disease, 14 in the patients with acute obstruction caused by emboli from cardiac cavities, and 9 in the patients with arterial embolism of other origin. We applied this procedure infusing Streptokinase intraarterially, continuously, directly and progressively in the thrombus, with a rate of 2-4000 unit/min, and a total dose more than 100,000-120,000 units. All patients had been consulted previously in a surgical unit and for different reasons surgical treatment was not indicated.

RESULTS

We succeeded to repermeabilise the entire arterial route at all the patients (fact demonstrated by the clinical and Doppler examinations). We obtained complete primary repermeabilisation in 79% cases (11 cases), and repermeabilisation at 24 hours in all cases. We did not record major complications during this procedure.

CONCLUSIONS

At the cases we studied (a small number), this method seems to be an alternative of therapy with good results in the restoration of obstructed arterial circulation. Intra-arterial administration of Streptokinase, in small doses, can eliminate the haemorrhagic and thromboembolic risks that appear in case of systemic administration of the drug.