Thrombolytic therapy for acute XXXX .

@entity1 @entity583 @entity548 @entity63 @entity2791 @entity1151 @entity1410 @entity292 @entity432 @entity715 @entity1211 @entity1779
To evaluate the role of selective intra-arterial low-dose thrombolytic therapy (SILDT) as an alternative to the surgical management of acute @entity432 , the hospital records of 40 @entity1 who underwent 43 SILDT treatments with either streptokinase (36) or urokinase (7) between December 1979 and March 1984 were reviewed. Twenty-eight @entity1 underwent 30 treatments (group 1) for native @entity432 and 12 @entity1 underwent 13 treatments (group 2) for prosthetic or autogenous graft occlusions. Therapy was deemed successful if subsequent surgical therapy was obviated. In group 1, SILDT was successful in 13 of 28 (45%) @entity1 with 12 of 25 lower extremity occlusions and one of three @entity432 . Successful lysis in the native @entity432 group fell into three categories: five @entity1 were successfully treated for arterial @entity715 complicating percutaneous transluminal angioplasty (PTA); four @entity1 required PTA after complete lysis revealed an underlying @entity2791 ; and only three required no further therapy after SILDT. SILDT failed in all three @entity1 with the @entity432 . Eleven @entity1 with femoral @entity432 and unsuccessful SILDT required six bypass procedures, three amputations, one embolectomy, and one PTA. In group 2 only 3 of 14 treatments (21%) were successful. Bypass revision was not possible in 11 @entity1 and all required amputation. Systemic fibrinolysis was seen in 20 (59%) of 34 @entity1 with available data. Neither fibrinogen levels nor fibrin degradation products predicted the occurrence of complications. Minor complications occurred in 18 of 43 (43%) treatments; small @entity1410 at the catheter entry site were most common. Minor complications occurred in 20 of 43 treatments (44%) and included severe local @entity548 (four), distant @entity548 (three), @entity1151 (four), @entity583 (three), unmasking of an @entity292 (one), and clot migration requiring emergency thrombectomy (four). SILDT is most effective in acute arterial @entity715 complicating arteriography or percutaneous angioplasty. It may play a role in the @entity1 in whom thrombolysis can reveal an underlying stenosis amenable to percutaneous angioplasty. This experience shows SILDT to be of limited value in the management of prosthetic autogenous graft occlusions. Finally, thrombolytic therapy is associated with significant morbidity and mortality rates and requires cautious monitoring to detect arterial @entity715 migration, worsening tissue @entity63 , @entity1211 , @entity1779 , and local or systemic @entity548 .
