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Urokinase Thrombolysis in Acute-on-Chronic Vascular Occlusion of Lower Limb

Department of Cardiothoracic and Vascular Surgery, SMS Medical College & Hospital, Jaipur, India

For reprint information contact: Chandra P Shrivastava, MCh, Tel: 91 141 256 0291 Ext. 475, Fax: 91 141 237 6329, Email: cps_sms{at}hotmail.com, H-16, Chitranjan Marg, C-Scheme, Jaipur-302001, Rajasthan, India.

Between January 2000 and June 2003, 70 patients (63 men and 7 women) with acute-on-chronic lower limb vascular occlusion underwent thrombolysis with 1 million units of urokinase. Forty-eight patients had unilateral and 22 had bilateral involvement; 9 had gangrenous changes. The mean age was 47 ± 9 years, 73% were smokers, and 13% had diabetes. The definition of a good response was either return of distal pulses or a warm limb and relief of pain at rest. Fifty-three (76%) patients (including 5 with gangrenous changes) had symptomatic improvement with thrombolysis (group 1), and 17 (24%) did not respond (group 2). All 70 patients (including 7 who later required amputation) underwent surgical intervention with a polytetrafluoroethylene interposition graft or arterioplasty. A good response to surgical treatment was found in significantly more patients (49/53, 92%) in group 1 compared to group 2 (7/17, 41%). Claudication distance after 6 months of follow-up improved in a significantly higher percentage of patients in group 1 (85%) than group 2 (38%). Preoperative thrombolysis improved the outcome and predicted the result of arterial surgery.