ABSTRACT
The plasma elastase level was measured as a marker of neutrophil degranulation in three groups, each of 15 patients, with uncomplicated varicose veins, lipodermatosclerosis (LDS) and venous ulceration. The values obtained were compared with those in age- and sex-matched control subjects. Significantly higher levels of elastase were found in all patient groups compared with controls: median 25.6 ng/ml for patients with uncomplicated varicose veins, 22.1 ng/ml for those with LDS, 26.0 ng/ml for those with venous ulceration. There was no difference in neutrophil count between the patient and control groups. These results provide evidence of increased neutrophil degranulation in patients with venous disease. The finding of raised elastase levels in all three patient groups shows that this was not due solely to the inflammatory process characterizing LDS and venous ulceration.
Subject(s)
Pancreatic Elastase/blood , Scleroderma, Localized/blood , Varicose Ulcer/blood , Varicose Veins/blood , Adult , Aged , Aging/blood , Female , Humans , Leukocyte Count , Male , Middle Aged , Neutrophil Activation , Neutrophils/metabolism , Pancreatic Elastase/metabolism , Scleroderma, Localized/metabolism , Varicose Ulcer/metabolism , Varicose Veins/metabolismABSTRACT
OBJECTIVE: The purpose of this study was to document the response to tissue plasminogen activator given as either a low-dose intra-arterial infusion or a bolus infusion in patients with peripheral arterial or bypass graft occlusion. DESIGN: Fifty thrombolytic procedures were carried out in 45 patients with a recent occlusion of a peripheral artery (41) or bypass graft (nine). A continuous infusion of 1.0 mg/h of tissue plasminogen activator was used in 27 patients (group A), while 23 patients were given a 20-mg bolus followed by an infusion of 1.0 mg/h (group B). Patients in the two groups were followed up for 12.1 +/- 9.3 months and 11.1 +/- 9.1 months, respectively. RESULTS: In group A, the angiographic lysis rate was 74% and clinical success rate was 67%. In group B, the comparable rates were 70% and 48%. Lysis was quicker when a bolus infusion was used, the mean lysis time being 14.4 +/- 7.9 hours compared with 26.7 +/- 9.4 hours following infusion alone (P = .0005). There was one instance of major hemorrhage in group A and eight in group B (P = .0022), including two patients with cerebral hemorrhage, one of whom died. CONCLUSION: Low-dose tissue plasminogen activator infusion is safe and reasonably effective, although a long treatment time is required. A bolus infusion regimen speeds lysis but is attended by a high incidence of serious hemorrhage.
Subject(s)
Graft Occlusion, Vascular/drug therapy , Peripheral Vascular Diseases/drug therapy , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/therapeutic use , Aged , Aged, 80 and over , Female , Humans , Infusions, Intra-Arterial , Male , Middle Aged , Thrombolytic Therapy/adverse effects , Tissue Plasminogen Activator/administration & dosageABSTRACT
PURPOSE: Low-dose intraarterial tissue plasminogen activator (t-PA) is effective in peripheral thrombolysis but treatment time is prolonged. The aim of this study was to determine whether a transthrombus bolus of t-PA before low-dose infusion shortens lysis time. METHODS: Twenty-three patients with peripheral arterial or bypass graft occlusion were treated with an initial bolus of 20 mg t-PA followed by a continuous infusion of 1 mg/hr. RESULTS: Angiographic lysis was achieved in 16 patients (70%) with a mean time to complete lysis of 14.4 +/- 7.9 hours. Two patients had reocclusion on days 1 and 3, respectively. There were three deaths within the first week of treatment, one from cerebral hemorrhage and two from myocardial infarction. A clinically successful outcome was achieved in 11 patients (48%). Those patients with patency at 1 week maintained this response at a mean follow-up of 11.7 +/- 9.1 months. Thrombolysis was unsuccessful in seven instances. In three of these cases the infusion had to be discontinued prematurely because of serious hemorrhage. Of the seven unsuccessful cases, three patients subsequently underwent a femorodistal bypass, two were left with tolerable ischemic symptoms, and two required a major amputation. There were eight major bleeding complications (35%), four at or adjacent to the catheter entry site and four at a distance, including two cases of cerebral hemorrhage, one of which was fatal. CONCLUSIONS: Transthrombus bolus delivery of tissue plasminogen activator followed by a low-dose infusion shortens lysis time, but this technique appears to be associated with an increased risk of serious hemorrhage.
Subject(s)
Thrombolytic Therapy , Thrombosis/drug therapy , Tissue Plasminogen Activator/therapeutic use , Adult , Aged , Aged, 80 and over , Catheterization, Peripheral/instrumentation , Cerebral Hemorrhage/etiology , Female , Femoral Artery , Follow-Up Studies , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/drug therapy , Hematoma/etiology , Hemorrhage/etiology , Humans , Infusions, Intravenous , Injections, Intralesional , Injections, Intravenous , Ischemia/drug therapy , Male , Middle Aged , Peripheral Vascular Diseases/diagnostic imaging , Peripheral Vascular Diseases/drug therapy , Popliteal Artery , Radiography , Thrombolytic Therapy/adverse effects , Thrombolytic Therapy/methods , Thrombosis/diagnostic imaging , Tissue Plasminogen Activator/administration & dosageABSTRACT
Significant injuries to major veins are life-threatening events and may lead to patient exsanguination. Treatment usually consists of direct suture repair. A case in which a serious iliac venous haemorrhage was not able to be controlled with the usual surgical procedures is reported. A desperate attempt to achieve haemostasis using orthopaedic staples was successful. The simplicity of this technique makes it a useful addition to the surgeon's armamentarium when dealing with life-threatening venous haemorrhage.
