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Although thrombolysis has been established for recanalization of acute and in part chronic peripheral artery occlusions, only smaller studies exist regarding the use of long- term rt-pa infiltration-thrombolysis. The objective of this study was to evaluate the benefit of additional long-term thrombolysis in patients with peripheral arterial occlusions for whom acute thrombolysis failed. From 1992 to 1997, 323 patients with peripheral arterial occlusions were treated with rt-pa (recombinant tissue-type plasminogen activator). When the thrombolysis failed during the first 3 hours, the thrombolytic therapy was continued as a long-term treatment with 3 mg rt-pa alternated by PGE1 (2.1 mL/hr for 3 hours, concentration: 20 μg/50 mL NaCl) every 3 hours. Additional heparin was applied in doses of 15,000 IE/24 hr or more to slightly increase the partial thromboplastin time. Angiographic controls were performed every 24 hours. If necessary, a final angioplasty was performed. In 142 of the 323 patients the occlusions were recanalized during the first 3 hours; 119 patients were treated with a long-term thrombolysis and in 72 (61%) a recanalization was ultimately achieved. Thus, the recanalization rate increased to 214 of 323 patients (p < 0.02). Mean treatment time was 2.8 ±2.2 days, range: 1 to 13 days. The rates of recanalization were not different in iliac, femoral, or crural arteries. Fibrinogen levels did not decrease during thrombolysis. Severe bleeding (with a decrease of more than 3 g/dL hemoglobin requiring transfusion) occurred in four patients after finishing the thrombolysis with short-term and in six with long-term therapy; two required surgical treatment. The 1-, 2-, and 3-year cumulative patency rates were respectively 90.1%, 74.2% and 64.9%. Patency rates in patients with acute or long-term thrombolysis were not different. A composite thrombolytic treatment using low-dose rt-pa in combination with PGE1 offers significantly better results than an acute thrombolytic treatment alone. It can be an effective and practicable regimen in about 60% of patients in whom acute thrombolysis fails. [ABSTRACT FROM AUTHOR]

The major reasons for venous thrombosis are inflammation, increased blood coagulability, and blood stasis. Investigation of these processes in vivo in a particular vein is difficult. Blood stasis in the peripheral veins is assumed to increase the risk of thrombosis during immobilization. By duplex sonography the authors were able to demonstrate different echogenicity in single veins of the lower limb in healthy subjects in a sitting position. Of 25 subjects, 7 presented a high echogenicity of the venous blood similar to that of the surrounding tissue. An additional 5 subjects presented this phenomenon after venous blood flow was stopped by a pressure cuff. The remaining 13 subjects still presented a dark lumen of the veins. Duplex sonography can discriminate different compositions of resting venous blood associated with venous stasis. Whether these findings correlate with an increased risk of thrombosis is not known. [ABSTRACT FROM AUTHOR]

A multicenter, prospective, placebo-controlled, double-blind trial was conducted to investigate the efficacy of intravenous infusion therapy with pentoxifylline over fourteen days in patients suffering from angiographically confirmed chronic peripheral occlusive arterial disease, Fontaine stage II, with at least a six-month history. After a washout phase of one week, the patients received in accordance with a randomization scheme either an i.v. infusion of 300 mg of pentoxifylline (15 mL ampoules) or 15 mL of a 0.9% NaCl solution in 250 mL of 5% laevulose, administered over three hours twice daily. The main efficacy parameters were treadmill-assessed initial claudication distance (ICD) and absolute claudication distance (ACD). Baseline testing revealed a mean ICD of 131 m in the pentoxifylline group and 126 m in the placebo cohort; mean ACD values were 239 m and 225 m respectively. The group of patients treated with pentoxifylline (n = 75) displayed a significantly greater improvement (p < 0.0001) in ICD (+70%) and ACD (+60%) than the placebo group did (+33% and 32%, respectively) (n = 79). The infusions were well tolerated in both groups. [ABSTRACT FROM AUTHOR]

In a double blind, randomized multicenter study naftidrofuryl, a vasoactive substance, was compared with placebo in the treatment of 104 patients with chronic arterial occlusive disease. After a run-in period of four weeks the patients received either naftidrofuryl (600mg daily) or placebo over 12 weeks. The pain-free and the total walking distances improved significantly in both groups. However, the difference in the improvement of the pain-free walking distance was significant (p < 0.02) in favour of naftidrofuryl. There also was a difference in the improvement of the total walking distance in favour of naftidrofuryl which was not significant. The results indicate that naftidrofuryl has a beneficial effect on the symp- toms and lengthens the painfree walking distance in patients with arterial occlusive disease. [ABSTRACT FROM AUTHOR]

Focuses on the effectiveness of flunarizine in treating occlusive arterial disease. Compensatory ability of the cardiovascular and pulmonary system; Orthopedic disturbances.

The Trans-Atlantic Inter-Society Consensus (TASC)-recommended absolute toe pressure is < 30-50 mm Hg for definition of chronic critical limb ischemia (CLI). Toe pressures can be measured by different techniques. The authors analyzed the clinical use of the Doppler technique and an automatic device with optical sensors and estimated their value in documentation of chronic critical limb ischemia compared to ankle artery pressures. Three different investigations were performed: (1) In 16 healthy subjects the digital artery pressures were measured by using 3 different optical sensors (transmission, reflection, and microcirculation sensor) and compared to the systolic brachial pressure. (2) In 50 patients with and without peripheral arterial occlusive disease the toe pressures at digits 1 and 2 of both feet were determined by Doppler technique (8 MHz) and by optical sensors (cuff width constant 1.5 cm) and were compared to the ankle artery pressure determined by Doppler technique. (3) In 175 patients the toe pressures were measured at 1 toe and the ankle artery pressures were determined. In this group they estimated the clinical use of the toe pressure in regard to the definition of CLI (toe pressure < 50 mm Hg) compared to the ankle pressure < 70 mm Hg. The digital artery pressures measured with the different optical sensors, and the systolic brachial pressures were not significantly different and the correlation coefficients were around 0.7. In 21 of 50 patients the toe pressure at D1 and D2 could not be measured by Doppler technique because with the applied cuff no Doppler signal could be detected at the tip of the toe, but in 24 of these 29 patients the optical measurement was possible. Mean toe pressures at D1 were 108 +/- 45 mm Hg and D2 102 +/- 45 mm Hg, which were statistically not different. The correlation coefficient for the highest ankle artery pressure and the highest toe pressure determined by the Doppler technique was 0.389; for the highest ankle artery pressure and the toe pressure measured by the optical sensors it was 0.369, and for the toe pressures measured by Doppler technique and the optical sensors it was 0.506. Defining systolic ankle artery pressure < or = 50 to 70 mm Hg as the golden standard for CLI, the sensitivity of optical toe pressure measurement for the detection of CLI was 8%, the specificity was 96%, the positive predictive value 12%, and the negative predictive value was 94%. Independent of technique the absolute systolic toe pressures did not correlate with the absolute systolic ankle pressures. The optical measurement was more suitable for toe pressure measurement because it could be used in 90% of all patients. All in all, toe pressure measurements are more useful to exclude CLI than to prove it.