A combined technique of local thrombolysis and regional neural blockade in severe venous occlusions.

Four patients with venous occlusions were treated with a combined technique including thrombolysis and regional sympathetic blockade. The thrombolytic therapy was achieved with streptokinase and/or urokinase infusion via venous catheter located distal to the obliteration in flow direction. The dose of the thrombolytic agents ranged between 40,000 and 200,000 U/h and lasted for a period of 3 days to 6 weeks. Subsequent anticoagulation using systemic low dose heparin was conducted for a further 2 weeks. Initial sympathetic blockade with concomitant analgesia and vasodilatation was accomplished by bupivacain either at the stellate ganglion or epidurally depending on the thrombus location. The circulation and function of the affected extremities were restored after lysis and no amputation was necessary. The described procedure seems to offer promising possibility in the treatment of severe venous thromboses in high-risk patients.