Abstract
Theoretically thrombolysis provides an attractive option in the therapy of the acutely
ischemic limb. This is particularly so since thrombosis on the background of arteriosclerotic
disease has become the common presenting cause, whereas previously the main cause
was embolic disease. This consideration also applies to the acutely occluded peripheral
vascular graft. Eighty-four patients who were treated with urokinase during a 24-month
period were studied retrospectively. Thrombosis was the cause of occlusion in 68 patients
(80.9%), and embolus was the cause in 16 (19.0%). In 17 patients (20.2%) there was
occlusion of a bypass graft, and in 67 patients (79.7%) there was occlusion of the
native artery. We also studied the effect of thrombolysis with acute occlusion in
25 patients who were diabetic. The time from onset of symptoms to beginning of treatment
was also considered. We believe that thrombolysis should have a place in the treatment
of the acutely occluded limb, but the physician should be aware of the potential complications
of thrombolytics, particularly hemorrhage. Furthermore, an adequate infrastructure
should be in place consisting of properly trained nursing staff and an angiography
facility providing service on a 24-hour basis.
