Thrombolytic therapy for acute arterial occlusion

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Presentation transcript:

Thrombolytic therapy for acute arterial occlusion Gregorio A. Sicard, M.D., John J. Schier, M.D., William G. Totty, M.D., Louis A. Gilula, M.D., Willard B. Walker, M.D., Edward E. Etheredge, M.D., Ph.D., Charles B. Anderson, M.D. Journal of Vascular Surgery Volume 2, Issue 1, Pages 65-78 (January 1985) DOI: 10.1016/0741-5214(85)90176-4 Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Perianastomotic extravasation complicating SILDT. A, Initial angiogram following unsuccessful catheter thrombectomy of PTFE composite sequential femoral-popliteal—posterior tibial artery bypass. B, Portable angiogram following 18 hours of infusion therapy with SK (5000 U/hr) showing extravasation at distal anastomosis despite partial lysis and revascularization of distal popliteal artery. Journal of Vascular Surgery 1985 2, 65-78DOI: (10.1016/0741-5214(85)90176-4) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Thrombus migration and distal embolization complicating SILDT. A, Initial portable angiogram following 2 hours of infusion therapy with SK (5000 U/hr) in patient presenting with acute popliteal artery thrombosis. Note rim contrast surrounding intraluminal thrombus (arrows), suggesting loosening of clot from vessel wall. B, Portable angiogram following 4 hours of SILDT showing partial lysis of clot throughout length of popliteal artery with residual unilateral clot fragments (arrows). C, Portable angiogram after 6 hours of SK infusion showing thromboembolism occluding tibial and branch vessels despite extensive clearing of popliteal clot. Clinical course was that of worsening foot ischemia and calf pain despite thrombolytic therapy. Journal of Vascular Surgery 1985 2, 65-78DOI: (10.1016/0741-5214(85)90176-4) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Unmasking of iatrogenic graft enteric fistula. A, Translumbar aortogram showing complete occlusion of interposition aortic bifurcation graft at level of renal arteries. B, Portable angiogram following 16 hours of SILDT (via retrograde axillary arterial catheter) showing local extravasation and aortoduodenal fistula complicating therapy despite extensive lysis of intraluminal thrombus. Journal of Vascular Surgery 1985 2, 65-78DOI: (10.1016/0741-5214(85)90176-4) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions