[Systemic venous thrombolysis with rt-PA in arterial embolism of the legs in the elderly].

Lower limb arterial embolism with blockage of a proximal artery is still a significant use of mortality, especially in elderly subjects. The excellent results achieved in acute myocardial infarction by the use of recombinant tissue plasminogen activator (rt-PA) have prompted us to apply this agent systemically i.v. in elderly patients with probably cardiogenic arterial embolism of the lower limbs. Out of 14 patients in our care, 9 have been submitted to this treatment after careful selection, and in 7 total or partial recanalization of the vessel has been achieved thus saving the limb involved. It can therefore be concluded, even on the basis of the small number of cases, that in selected cases thrombolytic management is possible, while avoiding the hemorrhagic complications attending arterial thrombolysis. This treatment can be applied in hospitals lacking the resources of angiographic diagnostics. The mechanism of action of rt-PA is such that at the doses administered critical changes of blood clotting parameters are not to be feared. Venous systemic thrombolysis can be performed mainly in elderly subjects whose precarious conditions may be upset by manoeuvres involving bleeding, sophisticated diagnostic or surgery.