Local thrombolysis in arterial occlusive disease.

In a series of 38 subjects intra-arterial catheters were used to infuse streptokinase (SK) or urokinase (UK) just proximal to an acute thromboembolic occlusion in 20 limbs or to perfuse SK directly into the obstructing material in 23 extremities with subacute or chronic occlusions by stepwise advancing the catheter until the distal open segment of the artery was reached. Dosage of SK varied between 50.000 U and 400.000 U and was administered during 1 to 4 hours. Patency could be achieved in 16 out of 20 acute occlusions and in 16 out of 23 chronically obstructed vessels within some hours. A systemic hyperlytic state of 12 to 24 hours duration was observed when total dosage of SK exceeded 80.000 U. In 9 patients thrombolysis was immediately followed by angioplasty. Advantage of the described technique is its rapid effectiveness, low cost, high success rate even in chronic femoro-popliteal occlusions and its applicability to patients in whom systemic thrombolysis would be considered contraindicated on account of old age or other causes.