Use and limitations of thrombolytic therapy in the treatment of peripheral arterial ischemia: results of a multi-institutional questionnaire.

In an attempt to assess the efficacy of thrombolytic infusions for arterial ischemia, a questionnaire was distributed to 142 vascular surgeons. Data from 45 respondents who had experience with thrombolytic infusion in 623 patients were reviewed. A successful outcome was obtained in 313 of 623 patients (50.2%). Morbidity was significant, with hemorrhage requiring transfusion or operation in 125 cases (20.1%) and major amputation in 103 cases (16.5%). There were nine strokes associated with thrombolytic infusion (1.4%), six of which were fatal. Sixteen deaths were associated with thrombolytic therapy, for a mortality rate of 2.5% (16 of 623 patients). Analysis of results by grouping centers according to numbers of lytic infusions failed to show significant correlation with center experience. Furthermore, morbidity and mortality were seen in centers with both limited and extensive experience with thrombolytic infusion. The initial enthusiasm for thrombolytic infusion to treat arterial ischemia is not substantiated by our data. Carefully controlled prospective trials are needed before this method can be offered as an alternative to arterial reconstruction.