Arterial thrombolysis in the lower extremity in vascular surgical practice]

The acute arterial thrombosis of the lower limb is dangerous not only for the limb, but it can cause life-threatening situation as well. That is why it is important to use different therapeutical modalities as the catheter guided intraarterial thrombolysis, which can reduce the surgical risks. All the drugs used for lysis now days are plasminogen activators. Due to the results of different studies the most appropriate drugs for optimal thrombolysis are the urokinase, the tissue-plasminogen activators and their recombinant forms. There are two major studies dealing with the effect of the different fibrinolytic drugs in comparison of the results of randomly operated patients. Both of these studies (STILE, TOPAS) determined a nearly same efficacy of both methods, operative or thrombolytic (approximately 70% amputation-free survival). Significant difference was observed in relation of occlusion of a native artery or a graft: better results could be obtained with surgery in case of arterial occlusion and conversely, it was in favor for thrombolysis if a graft was occluded. It must be noted that the thrombolysis has to be followed with endovascular or open surgical procedures in most of the cases. On the basis of our experiences and the data of literature we suggest after individual decision thrombolysis in case of graft occlusion, and surgery in case of arterial occlusion as first choice.