Local thrombolytic infusion in arterial ischemia of the upper limb: Mid-term results

Purpose Evaluation of local thrombolytic infusion in arterial ischemia of the upper limbs.Methods Thirteen patients, 4 male and 9 female, aged 31 to 83 (mean 63.6) were treated. The occlusion was determined to be thrombosis in 6 and cardiogenic embolism in 7 patients. Duration of symptoms varied from 2 hours to 3 weeks. Streptokinase (SK) was used in 4 patients at a rate of 5,000 units per hour, Urokinase (UK) in 8 patients at a rate of 75,000 units per hour and r-tPA in 1 patient at a rate of 4 mg per hour for 5 hours. Mean duration of infusion was 16 hours (3–39 hr) for SK and 35 hours (10–93 hr) for UK. Heparin was administered concommitantly at a rate of 300 to 1000 units per hour without a loading dose.Results Clinical limb salvage was obtained in all patients. Angiography showed complete clot dissolution and full clinical recovery in 8 patients. Five patients had partial clot clearing, 3 with full recovery and 2 with modest residual symptoms. One patient incurred a catheter-related transient cerebral ischemia, 1 patient a large arm hematoma from catheter-related trauma and 6 patients a moderate puncture site hematoma. Three patients died during the first month due to stroke, ventricular fibrillation, or cardiac failure, and 1 patient after 22 months from cardiac failure. No limb ischemia recurred during a follow-up of 1 to 5 years.Conclusion Local thrombolytic infusion is a safe and effective treatment for acute and subacute upper extremity arterial thromboembolism.