The results of a modified UHSK lysis in patients with PAOD are presented. UHSK was most successful in the treatment of stenoses of the abdominal aorta and iliac stenoses/occlusions. After occlusions of bypasses and after angioplasty UHSK was less successful. The results after 4 and 6 hours of UHSK treatment were almost the same.
With lysis-block technique an over-systolic tourniquet is put on the thigh or upper arm. The fibrinolytic substance is injected into a dorsal foot vein or forearm vein. By using this strictly local lysis it was possible to remove distal venous and arterial occlusions. During over-systolic blockade there was only a minimal link between the blocked part of the limb and systemic circulation. By choosing a lytic substance with a short half-life-period (rt-PA) the systemic effect after loosening the blockade was small. LBT is a new and interesting method for the fibrinolytic treatment of peripheral venous and arterial occlusions. The procedure is characterized by minimal systemic reactions and it can probably be applied in those patients with contraindications for systemic lysis.
In a retrospective study, the data of 218 patients (age 65-91) with obstructions of leg-arteries were evaluated, who underwent short-term ultrahigh fibrinolytic treatment. Some of the patients were also treated with percutaneous transluminal angioplasty after fibrinolysis. The overall patency-rate was 69 percent in the younger age group (65-74 years) and 46 percent in the group aged > or = 75. It could be shown, however, that the patency-rate was affected positively by concomitant factors (especially at least two patent calf arteries). These factors were less frequently found in the older age group, resulting in a lower patency-rate. Most likely the underlying reason is not age per se, because it could be shown, that the reason, which led to fibrinolytic treatment changed with age: In the younger age-group, Fontaine-stage II led to treatment in the vast majority of cases (71%). There was a shift to stage III (26%) and IV (27%) in the group > or = 75 years. This progression of artery disease usually leads to a reduced success rate of fibrinolytic treatment, because adverse concomitant factors prevail.
The release of tissue-type plasminogen activator (t-PA) after venous occlusion was tested in 290 patients with venous thrombosis, at earliest three months after the last thrombo-embolic episode. In 37 patients (12.8%) the t-PA-activity was decreased. In 14 patients (4.8%) the defect was confirmed by control. A reduced release of t-PA was found in 4 patients, while 10 out of 14 patients had comparatively higher levels of plasminogen-activator-inhibitor (PAI-I).
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