Intra-arterial infusion of urokinase for acute, critical ischemia in the lower limb

To assess the value of intra-arterial urokinase infusion in the management of acute, critical ischemia of the lower limb. A prospective study. A vascular surgery department within a university hospital. Twenty-five consecutive patients with acute, critical ischemia of the lower limb, excluding those requiring immediate surgical intervention. Follow-up ranged from 1 to 18 months. Angiography followed by intra-arterial infusion of urokinase. Angiographic and clinical evidence of clot lysis and limb reperfusion, any surgical procedures required and final clinical outcome. Urokinase was technically successful in lysing clot in 19 patients: 7 required no further treatment; in 8 an underlying lesion was identified and repaired by either percutaneous angioplasty or surgery; in the remaining 4 patients, although the clot was lysed, the limbs remained ischemic and, since reconstruction was considered impossible, amputation was required. Two patients improved clinically with little angiographic evidence of clot lysis. A total of nine patients required amputation, seven of these as a "primary" procedure after urokinase infusion. There were four episodes of significant morbidity but no deaths. Urokinase has a place in the management of acute vascular occlusion of the lower limb, not only in treating the occlusion but, equally importantly, in facilitating identification of lesions that require surgical intervention.