Peripheral artery and bypass graft thrombolysis with recombinant human tissue-type plasminogen activator Robert A. Graor, M.D., Barbara Risius, M.D.,

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Presentation transcript:

Peripheral artery and bypass graft thrombolysis with recombinant human tissue-type plasminogen activator Robert A. Graor, M.D., Barbara Risius, M.D., Jess R. Young, M.D., Kevin Denny, M.D., Edwin G. Beven, M.D., Michael A. Geisinger, M.D., Norman R. Hertzer, M.D., Leonard P. Krajewski, M.D., Fred V. Lucas, M.D., Patrick J. O'Hara, M.D., William F. Ruschhaupt, M.D., Sheila Winton, M.T., Margaret G. Zelch, M.D., Elliott B. Grossbard, M.D. Journal of Vascular Surgery Volume 3, Issue 1, Pages 115-124 (January 1986) DOI: 10.1016/0741-5214(86)90074-1 Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 A-C, Left leg arteriogram demonstrates occlusion of distal superficial femoral artery and poor distal arterial runoff in 43-year-old man with ischemic rest pain of 7 days' duration. D-F, Left leg arteriogram following 2 hours of t-PA infusion demonstrates significant thrombolysis in superficial femoral, popliteal, and peroneal arteries. Runoff into foot has been reestablished. Note atherosclerotic irregularity and marked narrowing at origin of popliteal artery. G, Arteriogram following percutaneous transluminal angioplasty demonstrates no significant residual stenosis. Journal of Vascular Surgery 1986 3, 115-124DOI: (10.1016/0741-5214(86)90074-1) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 A and B, Left leg arteriogram demonstrates occlusion of femoropopliteal bypass graft with poor distal arterial runoff in 38-year-old man with ischemic rest pain of 24 hours' duration. C-E, Arteriogram following 3 hours of t-PA infusion demonstrates recanalization of graft and tibial arteries with restoration of arterial flow into foot. Note marked stenosis as a result of intimal hyperplasia at graft anastomoses with popliteal and posterior tibial arteries. F and G, Intraoperative arteriogram demonstrates widely patent anastomoses and tibial runoff following revision of anastomotic sites. Journal of Vascular Surgery 1986 3, 115-124DOI: (10.1016/0741-5214(86)90074-1) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Mean changes in plasminogen (PMG), alpha-2 antiplasmin (A2PI), and fibrinogen (FIB) immediately following and 12 hours, 24 hours, and 10 days after t-PA infusion. Journal of Vascular Surgery 1986 3, 115-124DOI: (10.1016/0741-5214(86)90074-1) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 A and B, Intraoperative right femoral arteriogram demonstrates embolic occlusion of anterior and posterior tibial arteries in distal calf in 74-year-old man with 24 hours of ischemic rest pain. C, Intraoperative arteriogram following 93 minutes of t-PA infusion demonstrates considerable thrombolysis in both anterior and posterior tibial arteries. D, Intraoperative arteriogram following 135 minutes of infusion demonstrates further thrombolysis and opacification of multiple branches of plantar arch distally. Journal of Vascular Surgery 1986 3, 115-124DOI: (10.1016/0741-5214(86)90074-1) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Mean fibrinogen depletion immediately following and 12 hours after t-PA and streptokinase (SK) infusion. Journal of Vascular Surgery 1986 3, 115-124DOI: (10.1016/0741-5214(86)90074-1) Copyright © 1986 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions