Thrombolytic Treatment of Acute Peripheral Arterial and Venous Occlusions

Abstract

Patients with an acute arterial thrombosis or embolism must be brought to the hospital because of the danger of irreversible damage of the tissues. Thrombolysis correctly indicated may be a valuable complement to surgical treatment. The sooner thrombolysis is started, the earlier a complete success of therapy is possible. Lysis time directly depends on the age and length of the thrombus. The degree of ischemia and the localization of the thrombus are responsible for the decision between surgical and thrombolytic treatment. Intermittent claudication, acral lesions, or amputation should be prevented. If the arterial occlusion is not older than 2-3 days, thrombolytic therapy may succeed in 62% of thromboses, in 72% of embolism, and totally in 68%. Acute venous thromboses (deep veins of the pelvis and the extremities) must also be treated in the hospital as soon as possible without losing any time by pretreatment, unless heparin is given. The chance of thrombolysis in L-3 days-old venous occlusion is 69%. In 4-5 days-old thrombi, the success rate drops appreciably. After 6 days no thrombolysis may be expected because of the organization of the thrombus by connective tissue. Complete thrombolysis, in contrast to recanalization of the vessel, provides unhindered blood flow and preservation of sufficient valves of the veins. Timely thrombolytic therapy diminishes- the post-thrombotic syndrome. The risk of thrombolytic treatment has a feasible relation to the result of success in arterial and venous occlusions.