Thrombolytic therapy in an isolated limb. ³

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Goodman GR. Tersigni S. Li K. Lawrence PF. Department of Surgery, University of Utah School of Medicine, Salt Lake Annals of Vascular Surgery. 7(6):512-20, 1993 Nov. Intraoperative thrombolytic therapy is a useful adjunct to balloon catheter thromboembolectomy for treatment of acute embolism or thrombosis, but the technique is frequently limited by incomplete thrombolysis and Á systemic hemorrhage. In an attempt to improve results and reduce  complications of conventional thrombolytic therapy, urokinase was infused into a limb that was isolated with a tourniquet. This isolated limb perfusion technique was initially developed in an animal model and subsequently used for limb salvage in patients who failed thromboembolectomy. The animal model demonstrated that a fibrinolytic state could be achieved and isolated to the extremity, even when using extremely high dose (20,000 to 50,000 IU/kg) of thrombolytic agents. The fibrinogen level was unmeasurable and the prothrombin, partial thromboplastin, and thrombin times were significantly prolonged in the isolated limb (p < 0.001), whereas no changes occurred in these parameters in the systemic circulation. In seven patients, streptokinase (27,000 to * 200,000 IU) and urokinase (150,000 to 300,000 IU) were infused into isolated extremities after thrombectomy alone had failed to restore blood flow. All extremities showed improved perfusion after thrombolytic therapy Á and five remained viable 6 months after treatment. There were no systemic bleeding complications despite two patients having undergone major operations within 6 days. Tourniquet isolation of the limb can achieve extremely high concentrations of thrombolytic drugs while reducing the potential for systemic fibrinolysis and allows lysis of previously inaccessible thrombus. *