Local thrombolytic treatment in acute arterial oclusions

Abstract

Aim. Extremity ischemia emerging in relation with acute arterial obstruction is a severe condition which may at times result in the loss of extremity and rarely in that of the patient. Although surgical embolectomy is a method of choice in treatment, it may fail to succeed particularly in acute occlusions developing in chronic backgrounds. This study aims to detect the effectiveness of local thrombolytic agents as a method of treatment in acute arterial occlusions. Methods. 'Recombinant tissue plasminogen activator' (rt-PA) and intra-arterial local thrombolytic treatment were applied on 22 patients who had applied to Cardiovascular Surgery Clinic or Emergency Polyclinic between October 1999 and November 2001 with complaints of ache, coldness, cyanosis and disfunction in extremities. Of all the patients, 15 were male (68%) and 7 were female (31%). The age of the patients ranged between 38 and 75, and the average was 62.24. The amount of time which had passed between the initial symptoms and application to the hospital was 4 hours at least and 8 days at most, and the average was 48 hours. Results. 7 patients had thrombotic(31%) and 15 patients had embolic (68%) occlusions. Thrombolytic treatment proved to be fruitful in 12 patients (75%) of the embolic occlusion group and in 4 patients (57%) of the thrombolytic occlusion group. A total of 16 successfully treated patients corresponded to a percentage of 72.72% in the entire group. The ischemic period in the successfully treated group was between 4 hours and 6 days, and 36 hours in average. Surgical embolectomy was applied on 6 patients (27%) in whom thrombolytic treatment failed. The application time of these patients ranged between 24 hours and 8 days, and the average pertaining to this group was 52 hours. 3 of these patients (13%) died as a result of heart failure in the background and amputation was applied in 4 of them (18%). Embolectomy was achieved in 2 of these patients. Conclusion. Intra-arterial local thrombolytic treatment is a method of choice particularly in patients exhibiting general anesthesia risks due to decreased hospitalization period and lower amputation rate.