use of intraoperative R-tissue plasminogen activator in acute embolic ischaemia

ABSTRACT

Studies of intraoperative angiography have shown residual distal thrombi in 30% of patients undergoing emboloectomy. Both streptokinase and urokinase have been used intraoperatively to Iyse such thrombi. Side effects inclinde anaphylaxis, wound hoematoma, and systemic hypofibrinogenaemia. In this study recombinant tissue plasminogcn activator [rtPA] was used to lyse residual thrombi in 18 patients after transfemoral embolectomy. Complete lysis was achieved in 10 patients [55.5%], partial lysis in 5 patients [27.8%] and only 3 patients [16.7%] had no response. Limb salvage rate was 72.2%. There were no reported cases of allergic reactions, wound haematomas, or coagulation problems. The study shows that intraoperative tissue plasmoinogen activator [rtPA] is safe and effective in losing residual postembolectomy thrombi. Its use may avoid the need for more distal exploration