BACKGROUND: Recent controlled trials suggest that thrombolytic therapy may be an effective initial treatment for @entity432 . A major potential benefit of initial thrombolytic therapy is that @entity63 can be managed with less invasive interventions. METHODS: In this randomized, multicenter trial conducted at 113 North American and European sites, we compared vascular surgery (e.g., thrombectomy or bypass surgery) with thrombolysis by catheter-directed intraarterial recombinant urokinase; all @entity1 (272 per group) had had acute @entity432 for 14 days or less. Infusions were limited to a period of 48 hours (mean [+/-SE], 24.4+/-0.86), after which lesions were corrected by surgery or angioplasty if needed. The primary end point was the amputation-free survival rate at six months. RESULTS: Final angiograms, which were available for 246 @entity1 treated with urokinase, revealed recanalization in 196 (79.7 percent) and complete dissolution of @entity715 in 167 (67.9 percent). Both treatment groups had similar significant improvements in mean ankle-brachial blood-pressure index. Amputation-free survival rates in the urokinase group were 71.8 percent at six months and 65.0 percent at one year, as compared with respective rates of 74.8 percent and 69.9 percent in the surgery group; the 95 percent confidence intervals for the differences were -10.5 to 4.5 percentage points at six months (P=0.43) and -12.9 to 3.1 percentage points at one year (P=0.23). At six months the surgery group had undergone 551 open operative procedures (excluding amputations), as compared with 315 in the thrombolysis group. Major @entity548 occurred in 32 @entity1 in the urokinase group (12.5 percent) as compared with 14 @entity1 in the surgery group (5.5 percent) (P= 0.005). There were four episodes of @entity932 in the urokinase group (1.6 percent), one of which was fatal. By contrast, there were no episodes of @entity932 in the surgery group. CONCLUSIONS: Despite its association with a higher frequency of @entity548 , intraarterial infusion of urokinase reduced the need for open surgical procedures, with no significantly increased risk of amputation or @entity204 .

A comparison of recombinant urokinase with vascular surgery as initial treatment for XXXX . Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity932 :: ('MESH:D020300', 'Disease') :: ['intracranial hemorrhage'] @entity548 :: ('MESH:D006470', 'Disease') :: ['hemorrhagic complications', 'hemorrhage'] @entity63 :: ('MESH:D007511', 'Disease') :: ['limb ischemia'] @entity432 :: ('MESH:D001157', 'Disease') :: ['acute arterial occlusion of the legs', 'arterial obstruction of the legs'] @entity715 :: ('MESH:D013927', 'Disease') :: ['thrombus'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death']
@entity432 :: (MESH:D001157,Disease) :: ['acute arterial occlusion of the legs']
