Thirty-two patients with acute and subacute limb-threatening peripheral arterial ischaemia were treated with low dose intra-arterial
streptokinase infusions. The mean duration of infusion was 38 h. Six patients developed pericatheter
thrombosis and two had distal embolization of fragments of
thrombus but in all cases these responded to repositioning the
catheter and continuing the infusion. Five patients developed groin haematomata and in three of these there was evidence of a systemic fibrinolytic effect from the
streptokinase with plasma
fibrinogen reduced below 1 g/l. The most serious complication was perforation of the popliteal and tibial arteries which occurred on two occasions and required cessation of the infusion. Twenty-two patients (69 per cent) achieved
limb salvage, eight (25 per cent) suffered a major
amputation and two (6 per cent) died. The outcome was not related to the site, nature or duration of the
arterial occlusion but patients with loss of sensation or
paralysis of the affected limb were significantly less likely to obtain
limb salvage (P = 0.001). For occlusions greater than 30 cm in length a new technique was used where the
thrombus was lysed from distal to proximal in short lengths by gradual
catheter withdrawal. This was successful in five out of six cases. Low dose intra-arterial
streptokinase has been confirmed as an effective, relatively safe method of treatment in recent arterial ischaemia and can be recommended in situations where the results of surgery may not be favourable. In particular, patients with arterial
thromboses and no distal run-off, distal and late arterial emboli, thrombosed
popliteal aneurysms and patients after a failed
embolectomy, have all been shown to respond to
thrombolytic therapy with intra-arterial
streptokinase.