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PAPERS READ BEFORE THE 13TH ANNUAL MEETING OF THE NEW ENGLAND SOCIETY FOR VASCULAR SURGERY DIXVILLE NOTCH, NH, SEPT 25 TO SEPT 26, 1986 |

Thrombolysis in the Treatment of Peripheral Arterial Vascular Occlusions

Walter A. Koltun, MD; Geoffrey A. Gardiner Jr, MD; Donald P. Harrington, MD; Nathan P. Couch, MD; John A. Mannick, MD; Anthony D. Whittemore, MD
Arch Surg. 1987;122(8):901-905. doi:10.1001/archsurg.1987.01400200051008.
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• The efficacy of thrombolytic agents in the management of peripheral arterial disease remains unclear. We reviewed our experience with 64 consecutive episodes of limb-threatening graft or native vessel occlusions. The overall success rate was 59%, with a major complication/mortality rate of 28%. Thrombolytic therapy in patients with occluded vascular grafts required identification of a causative lesion and subsequent adjunctive management with percutaneous transluminal angioplasty or surgery for sustained patency (64%). In contrast, approximately 70% of native vessel occlusions maintained patency whether a causative lesion was identified and corrected or not. Patients who failed thrombolytic therapy had a worse prognosis overall, with 38% undergoing primary amputation, although patients with reconstructable occlusions still had a 64% salvage rate at six months. The review demonstrated that thrombolytic therapy continues to be a useful adjunct in treating the patient with peripheral vascular occlusion, although a significant risk of major complications persists. Patients with graft occlusions successfully treated with thrombolysis require correction of any precipitating lesions for long-term limb salvage, while careful management of patients failing thrombolysis can still achieve significant limb salvage in selected cases.

(Arch Surg 1987;122:901-905)

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