Thrombolysis of lower extremity embolic occlusions: a study of the results of the STAR Registry.

Abstract

To evaluate thrombolysis as primary therapy for lower extremity embolic occlusions. Forty-five of 306 consecutive cases of lower extremity arterial occlusions treated with urokinase and registered in the Society of Cardiovascular and Interventional Radiology Transluminal Angioplasty and Revascularization Registry were believed on the basis of clinical and angiographic findings to be due to emboli. Comorbidity included atrial fibrillation in 50%, previous myocardial infarction in 40%, and a cerebrovascular event in 35%. Thirty-two (71%) limbs were viable, 12 (27%) were threatened, and one had irreversible ischemia. Mean symptom duration was 8.6 days. Average occlusion length was 17 cm. The distribution of emboli was 4% aortoiliac, 65% femoropopliteal, 24% tibial, and 7% graft. Major complications occurred in eight of 45 patients (18%). The technical success rate was 69%, with a 1- and 2-year primary patency of 79% for initially successful intraarterial thrombolyses. Thrombolysis of embolic occlusions is successful in most cases. Limb salvage and survival rates are similar to historical reports for surgical embolectomy.