Intra-arterial thrombolysis of acute hand ischaemia with or without microcatheter: preliminary experience and comparison with the literature.

PURPOSE: This paper evaluates the indications, techniques, results, and complications of intra-arterial thrombolysis with or without a multihole microcatheter in three cases of acute hand ischaemia in comparison with the literature.
MATERIALS AND METHODS: Three men (mean age 39 years) with symptoms and signs of acute hand ischaemia (i.e. pain, pallor, cyanosis, decreased motor or sensory function) were studied with Doppler ultrasound and selective arteriography, which demonstrated acute clotting of wrist and/or hand arteries. They therefore underwent intra-arterial thrombolysis with the administration of urokinase and vasodilators and heparin if necessary, with (n=2) or without (n=1) multihole microcatheters.
RESULTS: In all three cases, partial or complete recanalisation of the occluded arteries was achieved, with almost complete remission of clinical symptoms and good recovery of hand function.
CONCLUSIONS: Percutaneous intra-arterial thrombolysis is an effective therapeutic approach in cases of acute hand ischaemia and is a valid alternative to surgical thrombectomy. Multihole microcatheters allow the thrombolytic agent to be distributed more evenly into the clot and may help to reduce reactive arterial spasm.