Late Results of a Prospective Study of Direct Intra-Arterial Urokinase Infusion for Peripheral Arterial and Bypass Graft Occlusions

The outcome of 72 direct intra-arterial urokinase infusions was studied prospectively. Thirty four were performed for native arterial occlusion and 38 for bypass graft occlusion; the immediate success rates were 67.5 and 84% respectively. The overall incidence of complications was 26%. Median follow-up was 36 (range 1–60) months. Seventeen patients (27%) died during follow-up; nine (14%) required a major amputation. Among patients with native arterial occlusion, 29% had no adjunctive procedure after thrombolysis; of these patients, 85% remained patent at a median of 21 (range 3–42) months. Among bypass occluded patients, only two (6%) had no lesion revealed after successful lysis; both bypasses remain patent at 54 and 58 months respectively. For patients treated with balloon angioplasty immediately after successful thrombolysis. 62% with native arterial occlusion remained patent at a median of 39 (range 2–60) months, whereas only 27% of bypass occlusion patients were patent at a median of 11 (range 2–40) months. Of patients requiring a surgical procedure after thrombolysis, 23 new bypasses (15 vein, eight prosthetic) were placed (nine in native arterial occlusion patients, 14 in bypass occlusion patients). In addition, there were 15 other surgical procedures, including six thrombectomies, four vein patch angioplasties, four vein jump grafts and one endarterectomy. The primary and secondary patencies for the 15 new vein bypasses placed were 81 and 88% respectively at a median follow-up of 36 months. Good immediate results were experienced with urokinase thrombolysis for peripheral arterial and graft occlusions. However, multiple adjunctive procedures were required to maintain patency. Balloon angioplasty yielded reasonable late patency for the native arterial group but poor patency for the bypass group. Replacement with a new bypass gave the best long-term patency in both groups. These data suggest that thrombolysis is a reasonable first-line treatment for limb ischemia due to native arterial occlusion. However, for bypass graft occlusion, the results, despite initial success, are not durable.