Modified rt-PA pulse-spray-lysis by hand for treatment of occluded leg arteries and femoropopliteal bypass grafts

Purpose: The evaluation of local rt-PA pulse-spray-lysis (PSL) by the Katzen(R) infusion wire for treatment of thrombosed leg arteries and bypass grafts. Material and method: 21 patients (mean age 64.4 years) with either occluded leg arteries (n = 19) or femorocrural bypass grafts (n = 2) were treated with PSL. Mean length of occlusion was 13.2 +/- 11.6 cm. Time of occlusion ranged from less than one week to 6 months. Results: In 71.43% (15/21) the occlusions could be successfully recanalized with PSl. The mean rt-PA dose was 10.7 +/- 4.9 mg. Remaining stenoses were handled with PTA (n = 9) and additional stent implantation (n = 3). Additional long-time-lysis with 17.5 mg rt-PA was necessary in two cases, the success rate increased to 81% (17/21). The ankle-brachial-index increased from 0.38 +/- 0.29 to 0.83 +/- 0.32 within 24 hours after intervention. In 4 cases bleeding complications occurred. 5 patients showed reocclusions during 6 months follow-up. Conclusions: Local fibrinolysis with rt-PA in PSL technique using the Katzen(R) infusion wire is a feasible and promising treatment of thrombosed leg arteries and grafts. Even careful and dosage-minimized rt-PA application cannot prevent bleeding complications.