Therapeutic efficiency of pulsed spray lysis in peripheral arterial occlusions

Purpose: To determine the clinical efficacy of pulse-spray thrombolysis. Material and methods: In a prospective trial 28 patients with acute arterial (n = 14) and bypass (n = 14) occlusions of the lower extremities were treated with pulse-spray thrombolysis. 23/28 legs were at risk. Results: Technical and clinical success were 89% and 68% respectively. Time interval until restitution of antegrade now was less than two hours, the median duration of the complete intervention was 17 hours. Two patients (7.1%) needed transfusions for inguinal haematomas. After six months 50% of occluded segments remained patent, secondary patency is comparable at 53%. By passes show significantly lower patency (p = 0.04) and higher amputation (p = 0.009) rates than native arteries. Bad run-off (less than or equal to 1 artery patent) is a significant predictor for clinical failure and early amputation. Conclusions: The distinct advantage of pulse-spray thrombolysis is fast restoration of antegrade flow and thereby effective treatment of acute ischaemia. The complication rate is low without associated mortality.