INTRODUCTION: Intra-arterial thrombolysis is commonly used as the initial treatment of acute or subacute @entity63 . METHODS: To evaluate the efficacy and cost of thrombolysis, we retrospectively analyzed 100 consecutive cases (87 @entity1 ) in which intra-arterial lysis (urokinase) was used as the initial treatment for native arterial lower @entity432 . The mean age of @entity1 was 67 years, 57% of the @entity1 were male, and preexisting @entity1095 was present in 74%. Presenting symptoms were limb-threatening @entity63 (53%) and @entity613 (47%). Acute symptoms (< 2 weeks' duration) were present in 48%. RESULTS: The 30-day morbidity rate was 31%, and four @entity1 died. Complications were significant @entity548 (23%), @entity385 (1%), and @entity177 with (2%) and without (2%) dialysis. Concomitant angioplasty was performed in 63%. Complete or significant lysis as demonstrated with angiography was achieved in 75% of iliac, 58% of femoropopliteal, and 41% of crural vessels (P <.001). Within 30 days of lysis, 9% of @entity1 underwent major amputation and 20% surgical revascularization (in 3 @entity1 the extent of revascularization was lessened by the lytic therapy). Amputation-free survival was 83% and 75% at 6 months and 2 years, respectively. Relief of @entity63 (defined as relief of @entity613 or limb salvage without major surgical intervention) was achieved in only 70% and 43% of @entity1 at 30 days and 2 years, respectively (Kaplan-Meier analysis; mean follow-up, 31 months). @entity1 with @entity66 had significantly better outcomes than those with @entity66 (P =.03). Duration or type of presenting symptoms did not predict outcome. The cost of the initial hospitalization per @entity1 for thrombolysis was  18,490. CONCLUSION: Thrombolysis can be as or more costly than surgery and is associated with a suboptimal outcome in a significant number of @entity1 . These data lead us to caution against a uniform policy of initial thrombolysis for @entity1 who present with @entity63 .

Thrombolysis for native XXXX of the lower extremities: clinical outcome and cost.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity1095 :: ('MESH:D016491', 'Disease') :: ['peripheral vascular disease'] @entity66 :: ('MESH:D004194', 'Disease') :: ['infrainguinal disease', 'aortoiliac disease'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding'] @entity63 :: ('MESH:D007511', 'Disease') :: ['lower extremity ischemia', 'ischemia'] @entity177 :: ('MESH:D051437', 'Disease') :: ['renal failure'] @entity613 :: ('MESH:D007383', 'Disease') :: ['claudication'] @entity432 :: ('MESH:D001157', 'Disease') :: ['extremity occlusive disease'] @entity385 :: ('MESH:D002544', 'Disease') :: ['ischemic stroke']
@entity432 :: (MESH:D001157,Disease) :: ['arterial occlusions']
