Local arterial thrombolysis

The best figures for primary success rates for local thrombolysis range from 69 to 85 per cent. Early recurrence occurs in approximately 10 per cent. Eight per cent of patients require amputation following failure of therapy. After successful therapy 80 per cent will be patent at 2 years. Recombinant tissue plasminogen activator is more effective than streptokinase and achieves earlier lysis. The thrombolytic agent is infused through an arterial catheter with its tip embedded in the proximal end of the thrombus. Recombinant tissue plasminogen activator is infused at a rate of 0.5 mg/h and progress is monitored angiographically. The average time to achieve reperfusion is 22 h. Vascular surgical back-up must be available. Thrombolytic therapy must not be given if there is evidence of irreversible ischemic damage.

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