RESUMEN
Aim: to evaluate the early and late results of thrombolysis in acute thrombotic ischaemia and graft occlusion
Patients and methods: in a prospective randomized study, 40 patients with thrombotic ischaemia were divided into two groups. Group A: 20 patients underwent thrombolytic therapy. Group B: 20 patients underwent surgical reconstruction
Results: group A: Prima y success in 17patients [85%]. Failure of thrombolysis in 3 patients [15%] Primary patency rate 85%. No mortality occurred during follow up. Group B: Primary success rate was 75 % [15 patients]. In 3 patients with acute thrombosis amputation was performed, one due to secondary hemorrhage and ligation of the graft .and the other two were due to graft failure and gangrene during the first month postoperatively. Mortality occurred in 2 patients [10%]
Conclusions: thrombolysis as compared with immediate surgery reduces the number of open procedures required for acute ischemia of the lower limb t7 allows some patients to avoid surgical intervention
RESUMEN
Current therapy of deep venous thrombosis [DVT] is to use heparin or low molecular weight heparin [LMWH] followed by oral anticoagulation. Patients with iliofemoral DVT represent a subset of patients who are not likely to respond to systemic lytic therapy. The introduction of direct catheter instillation of thrombolytic enzymes has not only improved the efficacy of thrombolytic therapy but has also reduced the risk of serious bleeding. This study included 80 patients that were divided into two groups. The first group: 40 patients with iliofemoral DVT treated with regional catheter directed thrombolysis. The second group: 40 patients with iliofemoral DVT treated with heparin followed by oral anticoagulation. In the first group complete lysis was achieved in 55% of patients and partial lysis in 40% of patients while in the second group neither complete nor partial lysis was achieved which was statistically significant P< 0.05. After 12 months, the first group showed complete patency in 70% of patients and partial patency in 30% of patients, while the second group showed complete patency in 5% and partial patency in 60% of patients which was also statistically significant P < 0.001. Catheter directed thrombolysis [CDT] was superior than anticoagulants in the management of iliofemoral [DVT], the results were promising as regards -Good and rapid degree of lysis.-High percentage of patency after 12 months -Lesser occurrence of venous reflux and post phlebitic symptoms, so the quality of life was improved by using CDT, with no recurrence of deep venous thrombosis after a follow up of 12 months