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, et al. Thrombolytic Treatment and Balloon Angioplasty in Chronic Occlusion of the Aortic Bifurcation. Ann Intern Med. 1994;120:40–44. doi: https://doi.org/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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