Selective management of XXXX with low-dose streptokinase.

@entity1 @entity6 @entity548 @entity1003 @entity3224 @entity432 @entity583
Fibrinolytic therapy has been reported as a limited @entity3224 in limb salvage. It is allegedly fraught with complications and pitfalls; however, the usage of low-dose streptokinase has never totally been explored. The purpose of this study was to examine the role of low-dose streptokinase in @entity432 . Nineteen @entity1 (12 @entity1 and 7 @entity1 ) with an average age of 68 years (range 37 to 79 years) and a total of 22 limbs under study were treated with low-dose streptokinase (initial intravenous dose of 10,000 units and a subsequent dose of 5,000 to 10,000 units/hour) for 1 to 3 days. Seven of the @entity1 underwent further operative intervention and four underwent angioplasty. Seven @entity1 had @entity6 controlled by insulin. Results were assessed clinically by angiography and by noninvasive measurement of distal pressure. Within 30 days of low-dose streptokinase therapy, four @entity1 died from a @entity583 that was thought to be part of their total disease process. Limited salvage occurred in 19 of 22 limbs at risk. Ten @entity1 (12 extremities) underwent subsequent balloon angioplasty or bypass surgery. There were three amputations. One @entity1 received a below-knee amputation rather than an expected above-knee amputation, one had a below-knee amputation, and one had an above-knee amputation. In all cases, the patency or lack thereof was confirmed by angiography. The mean ankle to brachial pressure indices increased from 0.07 +/- 0.15 to 0.64 +/- 0.14 after therapy. There were no prolonged hospital stays due to complications in any of the @entity1 . Selective infusions of low-dose streptokinase lyse thrombi, open collaterals, and provide an opportunity for extended surgery and angioplasty, increasing limb salvage without the risks of @entity1003 and @entity548 that may occur in full-dose thrombolysis.
