| Thrombolysis in acute peripheral arterial occlusion: predictors of immediate success. | |
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MedLine Citation:
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PMID: 8193001 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Thrombolytic therapy is frequently used for the treatment of peripheral arterial occlusion, but clinical predictors of success have not yet been defined. We prospectively evaluated 80 consecutive patients receiving intra-arterial urokinase for acute (< 14 days) ischemia. Fifty-five patients (69%) were treated for bypass graft occlusion and 25 patients (31%) for native arterial occlusion. Two primary outcome measures were evaluated using multivariate techniques (stepwise logistic regression) to determine the independent predictors of immediate arteriographic success: successful (> 80%) thrombolysis and avoidance of adjuvant operative or endovascular procedures. Independent variables examined included age, sex, comorbid conditions, severity, duration, etiology and location of the ischemic process, and positioning of the infusion catheter and guidewire. Overall, successful lysis was achieved in 57 patients (71%) and adjuvant procedures were avoided in 22 patients (28%). Successful outcome was more frequent in prosthetic graft (78%) and native arterial (72%) occlusions than in vein graft occlusions (53%, p = 0.017) and in nondiabetics than in diabetics (80% vs. 52%, p = 0.031). Lysis was dependent on placement of the catheter into the substance of the thrombus (85% vs. 0% success, p = 0.004) and passage of a guidewire through the occlusive process (92% vs. 10% success, p = 0.001). The only parameter independently predictive of successful outcome without the use of adjuvant procedures was the location of the occlusion; additional procedures were necessary in 88% of aortoiliac and 82% of infrainguinal occlusions vs. only 17% of upper extremity occlusions (p = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS) |
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Authors:
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C K Shortell; K Ouriel |
Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Annals of vascular surgery Volume: 8 ISSN: 0890-5096 ISO Abbreviation: Ann Vasc Surg Publication Date: 1994 Jan |
Date Detail:
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Created Date: 1994-06-24 Completed Date: 1994-06-24 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 8703941 Medline TA: Ann Vasc Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 59-65 Citation Subset: IM |
Affiliation:
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Department of Surgery, University of Rochester School of Medicine and Dentistry, N.Y. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adult Aged Aged, 80 and over Arterial Occlusive Diseases / drug therapy Female Graft Occlusion, Vascular / drug therapy* Humans Ischemia / drug therapy* Logistic Models Male Middle Aged Prospective Studies Thrombolytic Therapy* Treatment Outcome Urokinase-Type Plasminogen Activator / therapeutic use* |
| Grant Support | |
ID/Acronym/Agency:
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HL-30616/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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EC 3.4.21.73/Urokinase-Type Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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