1. Thrombolysis

2. What is it? A Procedure that removes or destroys clots A Procedure that removes or destroys clots Preformed in a Angio suit Preformed in a Angio suit Many times both a Radiologist and a Vascular surgeon Many times both a Radiologist and a Vascular surgeon Most common reason for during procedure is {peripheral Arterial Occlusive Disease Most common reason for during procedure is {peripheral Arterial Occlusive Disease

3. Techniques Introduction of catheter into the Femoral Artery Introduction of catheter into the Femoral Artery Catheter Advanced to the clot site Catheter Advanced to the clot site Different Drugs are administered to the site Different Drugs are administered to the site Streptokinase, Urokinase, or rtPA Streptokinase, Urokinase, or rtPA

4. Techniques Catheter placement in Femoral Artery

5. Techniques Local Low Dose Thrombolysis Local Low Dose Thrombolysis Discovered by Dotter in 1974 Discovered by Dotter in 1974 Less hazardous treatment Less hazardous treatment More efficient More efficient Pharmaceutical - Streptokinase Pharmaceutical - Streptokinase

6. Techniques Local Low-Dose Unlike other techniques at the time the dose is reduced to 1/20 the size Unlike other techniques at the time the dose is reduced to 1/20 the size Very popular in treating ilio-femoral Thrombosuses Very popular in treating ilio-femoral Thrombosuses

7. Techniques Local Low-Dose Advantages Advantages Pure drug right to thrombus Pure drug right to thrombus Protection of lytic agents from antibodies and inhibitors Protection of lytic agents from antibodies and inhibitors Loading dose not necessary Loading dose not necessary Shorter infusion time Shorter infusion time Less costly Less costly

8. Techniques Local Low-Dose

9. Techniques Urokinase Infusion This technique is most used for patients with low risk of tissue infarction This technique is most used for patients with low risk of tissue infarction Catheter is placed in the affected artery Catheter is placed in the affected artery Tip is placed 5 to 10mm from clot site Tip is placed 5 to 10mm from clot site Urokinase is infused at a rate of 60 ml/hr Urokinase is infused at a rate of 60 ml/hr Patient is brought back to department every 4 to 8 hours to check Clot Lysis Patient is brought back to department every 4 to 8 hours to check Clot Lysis

10. Techniques McNamara Infusion The procedure again uses the placement of catheters to the clot site The procedure again uses the placement of catheters to the clot site This procedure is specially used for patients at high risk for Limb or Organ lose This procedure is specially used for patients at high risk for Limb or Organ lose Much like the Low-Dose technique but, infusion rate is quadrupled for first 6 hours Much like the Low-Dose technique but, infusion rate is quadrupled for first 6 hours

11. Techniques McNamara Infusion Once clot shows signs of dissolving then rate is slowed to that of the Low-Dose technique Once clot shows signs of dissolving then rate is slowed to that of the Low-Dose technique If clot does not show any signs of breaking down the patients will often be sent to surgery to have organ or limb removed If clot does not show any signs of breaking down the patients will often be sent to surgery to have organ or limb removed

12. Techniques Hess Catheter is advanced to the clot site Catheter is advanced to the clot site Either Streptokinase or Urokinase can be used Either Streptokinase or Urokinase can be used A hand injected method is used A hand injected method is used 1 to 3 ml is given every 5 minutes 1 to 3 ml is given every 5 minutes

13. Techniques Hess Advantages Advantages Operator is able to view clot breaking down under fluoroscopy, chase clot as it moves Operator is able to view clot breaking down under fluoroscopy, chase clot as it moves Operator has full control of when drug is administered Operator has full control of when drug is administered Shorter procedure Shorter procedure