Low-dose direct fibrinolysis in peripheral vascular disease.

One hundred thirty patients underwent low-dose, catheter-directed fibrinolytic therapy for arterial and graft occlusions present for various periods of time. In 65 consecutive patients the therapeutic parameters were identical, and a careful hematologic evaluation was performed. In the subsequent 65 patients, varying doses of fibrinolytic agents were employed. Fibrinolytic therapy was found to be beneficial in a diverse group of clinical situations and in patients whose occlusions had occurred at varying lengths of time. Early study demonstrated that effective fibrinolysis can be achieved at approximately one-twentieth of the systemic level and that systemic effects could be avoided in all patients during 24-hour infusions and in many patients infused up to 96 hours. Bleeding complications occurred only in patients in whom concomitant heparinization was employed, and this was thought to be the causative factor. Therapeutic success and avoiding complications are strongly dependent on close monitoring of patients and joint decision making by the vascular surgeon and radiologist.