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ORIGINAL ARTICLES  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2002 December;43(6):877-80

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Intraoperative intra-arterial urokinase therapy after failed embolectomy in acute lower limb ischemia

Witz M. 1, Korzets Z. 2, Ellis M. 3, Shnaker A. 1, Lehmann J. 1

1 Vascular Surgery Unit, 2 Department of Nephrology, 3 Division of Transfusion Medicine, Meir General Hospital, Kfar Saba, affiliated to Tel-Aviv University Sackler School of Medicine Tel-Aviv, Israel


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Back­ground. Aim of ­this ­study is to eval­uate the use of intra­op­er­a­tive ­intra-arte­rial urok­i­nase infu­sion (­IIUI) in over­coming ­residual ­thrombi ­after throm­boem­bo­lec­tomy in ­acute ­lower ­limb ­ischemia.
­Methods. ­Design: ret­ro­spec­tive ­study ­over a 3-­year ­period. Set­ting: Uni­ver­sity affil­i­ated hos­pital. ­Patients: ­21 ­patients ­with ­acute ­lower ­limb ­ischemia who under­went ­IIUI ­after embo­lec­tomy (18 trans­fe­moral, 3 trans­pop­li­teal) had ­failed to ­achieve ade­quate ­distal per­fu­sion. Post­op­er­a­tively, all ­patients ­were main­tained on ­full ­dose hep­a­rin­iza­tion. ­Main out­come meas­ure­ments: com­plete or par­tial ­clot ­lysis on ­post-IIUI angio­graphy; res­to­ra­tion of ­pedal ­pulses and a ­viable leg at dis­charge.
­Results. Angio­graph­i­cally, com­plete and par­tial ­lysis was dem­on­strated in 14 and 3 ­patients, respec­tively. Two ­patients ­with pro­longed ­ischemia ­required fas­cio­tomy. One of ­these even­tu­ally had an ampu­ta­tion. Alto­gether, ­limb ampu­ta­tions (1 ­above ­knee, 2 ­below ­knee) ­were nec­es­sary in 3 ­patients. The angio­graphic appear­ance of ­lysis cor­re­lated ­well ­with the res­to­ra­tion of ­pedal ­pulses and/or ­limb ­viability. One ­patient ­died of myo­car­dial infarc­tion 3 ­days ­after the pro­ce­dure. Post­op­er­a­tively, ­there ­were 5 (24%) ­wound hemat­omas of ­which 1 ­required sur­gical explo­ra­tion. ­Over a ­mean ­follow-up ­period of 8 ­months (­range 1-16), ­limb sal­vage was sus­tained in the 17 ­patients ­with suc­cessful angio­graphic ­lysis.
Con­clu­sions. ­IIUI is an effec­tive ther­a­peutic ­adjunct to ­failed embo­lec­tomy in ­acute ­lower ­limb ­ischemia. Use of ­this pro­ce­dure is rec­om­mended as ­part of the rou­tine man­age­ment in ­such ­cases.

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