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Walter A. Koltun, MD; Geoffrey A. Gardiner, Jr, MD; Donald P. Harrington, MD; Nathan P. Couch, MD; John A. Mannick, MD; Anthony D. Whittemore, MD

Arch Surg. 1987;122(8):901-905.

Abstract
• The efficacy of thrombolytic agents in the management of peripheral arterial disease remains unclear. We reviewed our experience with 64 consecutive episodes of limb-threatening graft or native vessel occlusions. The overall success rate was 59%, with a major complication/mortality rate of 28%. Thrombolytic therapy in patients with occluded vascular grafts required identification of a causative lesion and subsequent adjunctive management with percutaneous transluminal angioplasty or surgery for sustained patency (64%). In contrast, approximately 70% of native vessel occlusions maintained patency whether a causative lesion was identified and corrected or not. Patients who failed thrombolytic therapy had a worse prognosis overall, with 38% undergoing primary amputation, although patients with reconstructable occlusions still had a 64% salvage rate at six months. The review demonstrated that thrombolytic therapy continues to be a useful adjunct in treating the patient with peripheral vascular occlusion, although a significant risk of major complications persists. Patients with graft occlusions successfully treated with thrombolysis require correction of any precipitating lesions for long-term limb salvage, while careful management of patients failing thrombolysis can still achieve significant limb salvage in selected cases.

(Arch Surg 1987;122:901-905)

Author Affiliations
From the Departments of Surgery (Drs Koltun, Couch, Mannick, and Whittemore) and Radiology (Drs Gardiner and Harrington), Harvard Medical School and Brigham and Women's Hospital, Boston.

Footnotes
Accepted for publication April 6, 1987.

Read before the 13th Annual Meeting of the New England Society for Vascular Surgery, Dixville Notch, NH, Sept 26, 1986.

Reprint requests to Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Dr Whittemore).

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