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

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 PGE1 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 intra-arterial rt-pa (3 mg in 3 h) followed by PGE1 (2.1 ml/h for 3 h, concentration: 20 micrograms/50 ml NaCl) in alternating order. Treatment times ranged from 1 to 7 days (2.9 +/- 1.6). Doses of 26.5 +/- 21.9 mg rt-PA and 20.4 +/- 16 micrograms 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.