Treatment of Occluded Arteries, Arterial Grafts, and Hemodialysis Access Sites Using Local Infusions of Urokinase

While local intraarterial lytic therapy is being used increasingly for the management of arterial occlusion and graft thrombosis [2, 5, 7, 9, 10, 13, 14, 17, 18, 20, 23, 32, 34], patient selection and the subsequent results remain controversial [22, 25]. The intent of this presentation is to outline our current philosophy of the use of intraarterial lytic therapy and its contrasting results in different clinical settings, using information gained from our recent experience with urokinase infusions in patients with occluded native arteries, arterial grafts, and hemodialysis access sites. In general, the clotted native artery and arterial graft patients in this series had advanced ischemia in the treated extremity. It has been our experience [27, 34] and that of others [9, 20] that surgery will ultimately become necessary in a high proportion of such patients, so that our approach with the initial lytic infusion is to avoid surgery when possible, but to operate earlier in the context of partial lysis rather than prolong the infusion in an attempt to achieve complete lysis.