Early results and I -year follow-up after i n t ra -a r t er i a I t h rorn bo I ysis Intra-arterial thrombolysis ( I A T ) M'US used as jirst-line treatment for 100 occ~lusions causing acute, subacute or chronic ischaemia. Streptokinase was used in 90 cases and tissue plasminogen activator in thc remcrininy ten. Complete lysis, as determined radiologically, was ucliimed in 55 per cent of cases and partial Iysis in 20 per cent. Lysis was m o r ~ eflectiue the earlier it was used. Major complications occurred in seiwi cases: five patients sufered major haemorrhage, two of whom died, and t,vo had haemorrhayic cerebrovascular accidents. Of the patients-with complete or partial clearance of thrombosis, 19 had no unclerlying apparent cause, 23 underwent angioplasty and 15 had an operation. The I-j'ear patency rate folloning complete lysis bvas 58 per cent. The I-year putency rate after successful treatment commencing ii'ithin I u e k of symptoms starting MWS 71 per cent, con~pared \r*ith 36 per cent for later treatment. Aortofemoral bifurcation grafts were cleared in three of five cases and all remain patent. Eight popliteal aneurysms were demonstrated by IAT and were ligated and bypassed; all these grafts remained patent at follow-up. IAT is less efective in chronic than acute occlusion. It should be reserved f o r patients in whom the occlusion is of short duration or for those with a thrombosed aortqfemoral bifurcation graft or popliteal aneurysm.
The role of intra-arterial thrombolysis (IAT) in the treatment of acute and chronic arterial occlusion remains unclear. Recent surveys of the practice of vascular surgeons in the U K confirmed that few centres had wide experience of the technique, the main reasons for which were lack of radiological support, doubts about efficacy, and insufficient ward staff'. Despite this, 50 per cent of surgeons had tried thrombolysis2, although most had experience of only a few cases per year.
Successful clearance of acute embolus and thrombosis occurs in 50-90 per cent of case^^.^ and, even with occlusion of longer duration. reasonable results have been reported. Hess and colleaguess and Lammer i't ( I / . " found IAT useful in thrombus of up to 6 months' duration, but the results worsened after this time. More recent reports have suggested that any nonorganized thrombus may be Iysed' . The reported complications of this type of tisatment have recently been reviewed'. Major haemorrhage occurs in 5 per cent of cases, stroke in I per cent and minor haemorrhage and catheter-related problems in approximately 15 per cznt. This paper describes the early and I-year results achieved in this unit with IAT. An attempt is made to define patients for whom the technique is appropriate and those for whom other forms of treatment may be better.