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Thrombolytic Treatment and Balloon Angioplasty in Chronic Occlusion of the Aortic Bifurcation

Ernst Pilger, MD; Martin Decrinis, MD; Gerhard Stark, MD; Gunther Koch, MD; Andrea Obernosterer, MD; Robert Tischler, MD; Marianne Lafer, MD; and Alexander Doder, MD
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From Karl-Franzens-University, Graz, Austria. Requests for Reprints: Ernst Pilger, MD, Division of Angiology, Department of Internal Medicine, Karl-Franzens-University, Auenbruggerplatz 15, A-8036 Graz, Austria.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(1):40-44. doi:10.7326/0003-4819-120-1-199401010-00007
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Objective: To evaluate nonsurgical alternatives in reopening chronically occluded aortic bifurcation.

Design: Uncontrolled randomized study.

Setting: University-affiliated referral center for vascular diseases.

Patients: 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.

Intervention: 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.

Results: 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.

Conclusion: 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.


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Figure 1.
Overall results of thrombolytic treatment and subsequent therapy in patients with totally occluded aortic bifurcation.

PTA = percutaneous transluminal angioplasty.

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Figure 2.
Cumulative recanalization rates with different types of thrombolytic therapy.

Ten patients received 0.05 mg/kg body weight per hour of recombinant tissue-type plasminogen activator (rt-PA) for a maximum of 5 days; 8 patients received 100 000 IU/h of streptokinase (SK) for a maximum of 7 days; and 7 patients received 150 000 IU/h of urokinase (UK) for a maximum of 14 days.

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Figure 3.
Ankle/arm pressure ratio in patients with totally occluded aortic bifurcation before and after reopening and during the follow-up period.

PTA = percutanous transluminal angioplasty.

Grahic Jump Location




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