LYSIS OF ARTERIAL CLOT BY INTRAVENOUS OR INTRA-ARTERIAL ADMINISTRATION OF STREPTOKINASE

Abstract

Intra-arterial thrombolysis with streptokinase was studied in 38 patients. The indications were peripheral thromboembolism in 9 patients (group 1), postreconstruction graft thrombosis in 26 patients (group 2) and renal artery thrombosis in 3 patients (group 3). The intra-arterial route was used for the 1st and 3rd groups and in 16 of the 2nd group. The i.v. route was used in the remaining 10 patients. Lysis was achieved in all of the group 1 and 3 patients. The latter were also treated with percutaneous transluminal angioplasty after dissolution of thrombus of the renal artery. In group 2 patients, lysis was achieved in 8 of 16 patients in whom lytic therapy was instituted within 7 days of graft closure. There was no lysis in all 10 patients in whom elapsed time was more than 7 days. Postlytic angiographic visualization of etiologic mechanisms for thrombosis enabled subsequent successful correction in 3 of 5 patients in group 2. Attempts to correct graft failure by surgical treatment when lysis had failed were often unsuccessful (12 of 17). Lytic therapy is most effective for acute embolic occlusion and for thrombosis of less than 7 days duration. Although there is no difference in drug efficacy by route of administration, a lesser number of complications (such as fever and hematoma) occurred with intra-arterial infusion. The effectiveness of lysis is also directly related to the collateral circulation and runoff beyond the occlusion. Lysis is not indicated for severe acute ischemia if surgical treatment is an alternative or it may cause distal embolism as with complete axillofemoral graft thrombosis. Lytic therapy is least effective for graft thrombosis with pre-existant poor runoff.