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Recanalization of chronic peripheral arterial occlusions by alternating intra-arterial rt-PA and PGE1

Recanalization of chronic peripheral arterial occlusions by alternating intra-arterial rt-PA and PGE1

Vasa. Zeitschrift für Gefasskrankheiten 27(1): 20-23

Background: Recanalization of femoral artery occlusions is difficult and different forms of intra-arterial lysis or mechanical procedures have been described. We investigated the effectiveness of a prolonged intra-arterial lysis with rt-pa in combination with PGEI followed by angioplasty. Patients and Methods: 43 patients (age 60.4 +- 14.3 years) with peripheral arterial occlusions older than 3 months and longer than 10 cm were treated with intraarterial rt-pa (3 mg in 3 h) followed by PGE1 (2.1 ml/h for 3 h, concentration: 20 mug/50 ml NaCl) in alternating order. Treatment times ranged from 1 to 7 days (2.9 +- 1.6). Doses of 265 +- 21.9 mg rt-PA and 20.4 +- 16 mug PGE1 were used. If necessary, angioplasty was performed after a wire was passed through the lumen. Results: Recanalization was achieved in 47 out of 85 arterial segments with reocclusion in 9 segments. The arterial perfusion deteriorated once due to peripheral embolism. Other adverse effects included one case of retroperitoneal and one case of intracrural bleeding and one aneurysma spurium. Conclusion: In chronic arterial occlusions which do not respond to conventional angioplasty and/or short term fibrinolysis recanalization may be achieved in about 50% by means of prolonged alternating application of rt-pa and PGE1.

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Accession: 009304294

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PMID: 9540428

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