Thrombolysis in the Treatment of Peripheral Arterial Vascular Occlusions

Walter A. Koltun, Geoffrey A. Gardiner, Donald P. Harrington, Nathan P. Couch, John A. Mannick, Anthony D. Whittemore

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Abstract

The efficacy of thrombolytic agents in the management of peripheral arterial disease remains unclear. We reviewed our experience with 64 consecutive episodes of limb-threatening graft or native vessel occlusions. The overall success rate was 59%, with a major complication/mortality rate of 28%. Thrombolytic therapy in patients with occluded vascular grafts required identification of a causative lesion and subsequent adjunctive management with percutaneous transluminal angioplasty or surgery for sustained patency (64%). In contrast, approximately 70% of native vessel occlusions maintained patency whether a causative lesion was identified and corrected or not. Patients who failed thrombolytic therapy had a worse prognosis overall, with 38% undergoing primary amputation, although patients with reconstructable occlusions still had a 64% salvage rate at six months. The review demonstrated that thrombolytic therapy continues to be a useful adjunct in treating the patient with peripheral vascular occlusion, although a significant risk of major complications persists. Patients with graft occlusions successfully treated with thrombolysis require correction of any precipitating lesions for long-term limb salvage, while careful management of patients failing thrombolysis can still achieve significant limb salvage in selected cases.

Original languageEnglish (US)
Pages (from-to)901-905
Number of pages5
JournalArchives of Surgery
Volume122
Issue number8
DOIs
StatePublished - Aug 1987

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Blood Vessels
Thrombolytic Therapy
Limb Salvage
Transplants
Therapeutics
Fibrinolytic Agents
Peripheral Arterial Disease
Amputation
Angioplasty
Extremities
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Koltun, W. A., Gardiner, G. A., Harrington, D. P., Couch, N. P., Mannick, J. A., & Whittemore, A. D. (1987). Thrombolysis in the Treatment of Peripheral Arterial Vascular Occlusions. Archives of Surgery, 122(8), 901-905. https://doi.org/10.1001/archsurg.1987.01400200051008
Koltun, Walter A. ; Gardiner, Geoffrey A. ; Harrington, Donald P. ; Couch, Nathan P. ; Mannick, John A. ; Whittemore, Anthony D. / Thrombolysis in the Treatment of Peripheral Arterial Vascular Occlusions. In: Archives of Surgery. 1987 ; Vol. 122, No. 8. pp. 901-905.
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Koltun, WA, Gardiner, GA, Harrington, DP, Couch, NP, Mannick, JA & Whittemore, AD 1987, 'Thrombolysis in the Treatment of Peripheral Arterial Vascular Occlusions', Archives of Surgery, vol. 122, no. 8, pp. 901-905. https://doi.org/10.1001/archsurg.1987.01400200051008

Thrombolysis in the Treatment of Peripheral Arterial Vascular Occlusions. / Koltun, Walter A.; Gardiner, Geoffrey A.; Harrington, Donald P.; Couch, Nathan P.; Mannick, John A.; Whittemore, Anthony D.

In: Archives of Surgery, Vol. 122, No. 8, 08.1987, p. 901-905.

Research output: Contribution to journalArticle

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N2 - The efficacy of thrombolytic agents in the management of peripheral arterial disease remains unclear. We reviewed our experience with 64 consecutive episodes of limb-threatening graft or native vessel occlusions. The overall success rate was 59%, with a major complication/mortality rate of 28%. Thrombolytic therapy in patients with occluded vascular grafts required identification of a causative lesion and subsequent adjunctive management with percutaneous transluminal angioplasty or surgery for sustained patency (64%). In contrast, approximately 70% of native vessel occlusions maintained patency whether a causative lesion was identified and corrected or not. Patients who failed thrombolytic therapy had a worse prognosis overall, with 38% undergoing primary amputation, although patients with reconstructable occlusions still had a 64% salvage rate at six months. The review demonstrated that thrombolytic therapy continues to be a useful adjunct in treating the patient with peripheral vascular occlusion, although a significant risk of major complications persists. Patients with graft occlusions successfully treated with thrombolysis require correction of any precipitating lesions for long-term limb salvage, while careful management of patients failing thrombolysis can still achieve significant limb salvage in selected cases.

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