Skip to main content
SpringerLink
Log in

Local thrombolytic infusion in arterial ischemia of the upper limb: Mid-term results

  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Evaluation of local thrombolytic infusion in arterial ischemia of the upper limbs.

Methods

Thirteen patients, 4 male and 9 female, aged 31 to 83 (mean 63.6) were treated. The occlusion was determined to be thrombosis in 6 and cardiogenic embolism in 7 patients. Duration of symptoms varied from 2 hours to 3 weeks. Streptokinase (SK) was used in 4 patients at a rate of 5,000 units per hour, Urokinase (UK) in 8 patients at a rate of 75,000 units per hour and r-tPA in 1 patient at a rate of 4 mg per hour for 5 hours. Mean duration of infusion was 16 hours (3–39 hr) for SK and 35 hours (10–93 hr) for UK. Heparin was administered concommitantly at a rate of 300 to 1000 units per hour without a loading dose.

Results

Clinical limb salvage was obtained in all patients. Angiography showed complete clot dissolution and full clinical recovery in 8 patients. Five patients had partial clot clearing, 3 with full recovery and 2 with modest residual symptoms. One patient incurred a catheter-related transient cerebral ischemia, 1 patient a large arm hematoma from catheter-related trauma and 6 patients a moderate puncture site hematoma. Three patients died during the first month due to stroke, ventricular fibrillation, or cardiac failure, and 1 patient after 22 months from cardiac failure. No limb ischemia recurred during a follow-up of 1 to 5 years.

Conclusion

Local thrombolytic infusion is a safe and effective treatment for acute and subacute upper extremity arterial thromboembolism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Welling RF, Cranley JJ, Krause RJ (1981) Obliterative arterial disease of the upper extremity. Arch Surg 116:1593–1596

    Google Scholar 

  2. Champion HR, Gill W (1973) Arterial embolus to the upper limb. Br J Surg 60:505–508

    Google Scholar 

  3. Thompson JE (1974) Acute peripheral arterial occlusions. N Engl J Med 290:950–952

    Google Scholar 

  4. Gross WS, Flanigan DP, Kraft RO, Stanley JC (1978) Chronic upper extremity arterial insufficiency: Etiology, manifestations and operative management. Arch Surg 113:419–423

    Google Scholar 

  5. Mc Namara MF, Takaki HS, Yao JST, Bergan JJ (1978) A systematic approach to severe hand ischemia. Surgery 83:1–11

    Google Scholar 

  6. Holleman JH Jr, Hardy JD, Williamson JW, Raju S, Neely WA (1980) Arterial surgery for arm ischemia: A survey of 136 patients. Ann Surg 191:727–737

    Google Scholar 

  7. Schmidt FE, Hewitt RL (1980) Severe upper limb ischemia. Arch Surg 115:1188–1191

    Google Scholar 

  8. Lambert M, Ball C, Hancock J (1983) Management of acute brachial artery occlusion due to trauma or emboli. Br J Surg 70:639–640

    Google Scholar 

  9. Bandyk DF, Thiele BL, Radke HM (1981) Upper-extremity emboli secondary to axillo-femoral graft thrombosis. Arch Surg116:393–395

    Google Scholar 

  10. Mills JL, Friedman EL, Taylor LM, Porter JM (1987) Upper extremity ischemia caused by small artery disease. Ann Surg 206:521–529

    Google Scholar 

  11. Scher LA, Veith FJ, Samson RH, Gupta SK, Ascer E (1986) Vascular complications of thoracic outlet syndrome. J Vasc Surg 3:565–568

    Google Scholar 

  12. Buckspan GS, Franklin JD, Novak GR, Bennett BD, Lynch JB, Dean RH (1978) Intra-arterial drug injury: Studies of etiology and potential treatment. J Surg Res 24:294–301

    Google Scholar 

  13. Ricotta JJ, Scudder PA, Mc Andrew JA, De Weese JA, May AG (1983) Management of acute ischemia of the upper extremity. Am J Surg 145:661–665

    Google Scholar 

  14. Holleman JH, Hardy JD, Williamson JW, Raju S, Neely WA (1980) Arterial surgery for arm ischemia: A survey of 136 patients. Ann Surg 191:727–744

    Google Scholar 

  15. Dotter CT, Rosch J, Seaman AJ (1974) Selective clot lysis with low-dose streptokinase. Radiology 111:31–37

    Google Scholar 

  16. Tisnado J, Cho SR, Beachley MC, Venes FS (1985) Low-dose fibrinolytic therapy in hand ischemia. Semin Intervent Radiol 2:367–374

    Google Scholar 

  17. Mori KW, Bookstein JJ, Heeney DJ, Bardin JA, Donnely KJ, Rhodes GA, Dilley RB, Warmath MA, Bernstein EF (1983) Selective streptokinase infusion: Clinical and laboratory correlates. Radiology 148:677–682

    Google Scholar 

  18. Von Ryll Gryska P, Raker EJ (1983) Post embolectomy thrombosis treated with intra-arterial streptokinase. Angiology 34:620–625

    Google Scholar 

  19. Schild H, Schuster CJ, Grönniger J, Schmied W, Weilemann L, Lindner P, Wagner P, Brunier A, Thelen M, Meyer J (1987) Lokale Fibrinolysetherapie von Gefässverschlüssen im Becken-Bein-Bereich und der oberen Extremität. Fortschr Röntgenstr 146:57–62

    Google Scholar 

  20. Katzen BT, van Breda A (1981) Low dose streptokinase in the treatment of arterial occlusions. AJR 136:1171–1178

    Google Scholar 

  21. Graor RA, Risius B, Young J, Geisinger MA, Zelch MG, Smith JAM, Ruschhaupt WF (1984) Low-dose streptokinase for selective thrombolysis: Systemic effects and complications. Radiology 152:35–39

    Google Scholar 

  22. Abu-Nema T, Ayyash K, Wafaii IK, Al-Hassan J, Thulesius O (1988) Jellyfish sting resulting in severe hand ischemia successfully treated with intra-arterial urokinase. Injury 19:294–296

    Google Scholar 

  23. Lloyd WK, Porter JM, Lindell TD, Rösch J, Dotter CT (1973) Accidental intraarterial injection in drug abuse. AJR 117:892–895

    Google Scholar 

  24. Berni GA, Bandyk DF, Zierler RE, Thiele BL, Strandness E (1983) Streptokinase treatment of acute arterial occlusion. Ann Surg 198:185–191

    Google Scholar 

  25. Sicard GA, Schier JJ, Totty WG, Gilula LA, Walker WB, Etheredge EE, Anderson CB (1985) Thrombolytic therapy for acute arterial occlusion. J Vasc Surg 2:65–78

    Google Scholar 

  26. Slany J, Enzenhofer V, Karnik R (1984) Local thrombolysis in arterial occlusive disease. Angiology 35:231–237

    Google Scholar 

  27. Lang EV, Bookstein JJ (1989) Accelerated thrombolysis and angioplasty for hand ischemia in Buerger's disease. Cardiovasc Intervent Radiol 12:95–97

    Google Scholar 

  28. Edwards JM, Antonius JI, Porter JM (1985) Critical hand ischemia caused by forearm fibromuscular dysplasia. J Vasc Surg 2:459–463

    Google Scholar 

  29. Hargrove WC, Barker CF, Berkowitz HD, Perloff LJ, McLean G, Freiman D, Ring EJ, Roberts B (1982) Treatment of acute peripheral arterial and graft thromboses with low-dose streptokinase. Surgery 92:981–993

    Google Scholar 

  30. Corser G, Masey S, Jacob G, Kernoff P, Browne D (1985) Ischemia following selfadministered intra-arterial injection of methylphenidate and diamorphine. Anaesthesia 40:51–54

    Google Scholar 

  31. Rapoport S, Glickman MG, Salomon JC, Cuono CB (1985) Aggressive postoperative pharmacotherapy for vascular compromise of replanted digits. AJR 144:1065–1066

    Google Scholar 

  32. Comerota AJ, White JV, Grosh JD (1989) Intraoperative intraarterial thrombolytic therapy for salvage of limbs in patients with distal arterial thrombosis. Surg Gynecol Obstet 169:283–289

    Google Scholar 

  33. Widlus DM, Venbrux AC, Benenati JF, Mitchell SE, Lynch-Nyhan A, Cassidy FP, Osterman FA (1990) Fibrinolytic therapy for upper-extremity arterial occlusions. Radiology 175:393–399

    Google Scholar 

  34. Belkin M, Belkin B, Bucknam CA, Straub JJ, Lowe R (1986) Intra-arterial fibrinolytic therapy. Arch Surg 121:769–773

    Google Scholar 

  35. Jelalian C, Mehrhoff A, Kelmann Cohen I, Richardson J, Merritt WH (1985) Streptokinase in the treatment of acute arterial occlusion of the hand. J Hand Surg 10A:534–538

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Imaging, University Hospital Sart Tilman, Domaine du Sart Tilman B 35, 1, Liège, Belgium

    Michel Coulon & Robert F. Dondelinger

  2. Department of Radiology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, B-1200, Brussels, Belgium

    Pierre Goffette

Authors
  1. Michel Coulon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pierre Goffette
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert F. Dondelinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Coulon, M., Goffette, P. & Dondelinger, R.F. Local thrombolytic infusion in arterial ischemia of the upper limb: Mid-term results. Cardiovasc Intervent Radiol 17, 81–86 (1994). https://doi.org/10.1007/BF00193922

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00193922

Key words

Search

Navigation