Ernst Pilger, MD; Martin Decrinis, MD; Gerhard Stark, MD; Gunther Koch, MD; Andrea Obernosterer, MD; Robert Tischler, MD; Marianne Lafer, MD; Alexander Doder, MD
To evaluate nonsurgical alternatives in reopening chronically occluded aortic bifurcation.
Uncontrolled randomized study.
University-affiliated referral center for vascular diseases.
Twenty-five of 39 consecutive patients with chronic aortoiliac disease including a totally occluded aortic bifurcation were found to be acceptable candidates for an aortobifemoral prosthetic graft.
Patients were randomly assigned to receive either streptokinase or urokinase or recombinant tissue-type plasminogen activator (rt-PA). In cases of successful thrombolysis and residual obstructions, subsequent balloon angioplasty was attempted. Prosthetic bypass grafting was done if thrombolytic treatment and balloon angioplasty failed.
Complete lysis was achieved in 5 of 25 patients (20%). In 10 (40%) patients, lysis showed residual obstructions, which were reopened mechanically in 8 patients; 2 patients had extra-anatomical bypass grafts. Ten patients (40%) without thrombolysis had surgical aortobifemoral bypass grafts. Overall, recanalization and clinical improvement were achieved in 13 of 25 patients (52%) by thrombolytic therapy and subsequent balloon angioplasty. The recanalization rate did not differ among the different thrombolytic drugs. However, rt-PA therapy resulted in reopening after 4 days of treatment; streptokinase, after 6 days; and urokinase, after 9 days (P < 0.005). No major complications or deaths occurred.
Thrombolytic treatment followed by balloon angioplasty may help avoid the need for aortobifemoral prosthetic bypass grafting in more than 50% of patients with chronic aortoiliac disease.
Pilger E, Decrinis M, Stark G, Koch G, Obernosterer A, Tischler R, et al. Thrombolytic Treatment and Balloon Angioplasty in Chronic Occlusion of the Aortic Bifurcation. Ann Intern Med. ;120:40–44. doi: 10.7326/0003-4819-120-1-199401010-00007
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Published: Ann Intern Med. 1994;120(1):40-44.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine, Venous Thromboembolism.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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