Thrombolysis and thromboaspiration for acute thromboembolic occlusion in the upper extremity.

Purpose: To report technical aspects of thrombolysis and thromboaspiration for acute thromboembolic occlusion in the upper extremity.

Materials And Methods: This study included four consecutive patients with acute thromboembolic occlusion in the upper extremity (right arm, n = 3; left arm n = 1). The mean patient age was 81.3 ± 11.5 years (mean ± standard deviation; range 69-92 years) and all patients had chronic atrial fibrillation. Emergent angiography was performed via the femoral artery.

Results: Thromboembolic occlusion was demonstrated in the axillary artery (n = 2), axillary and radial arteries (n = 1), and brachial, radial, and ulnar arteries (n = 1). Endovascular treatment was performed via the unaffected brachial (n = 3) or radial artery (n = 1). Thrombolysis was performed for three patients using 360,000-480,000 IU (mean 400,000 ± 69,000 IU) urokinase, including 12-h continuous infusion in one. Thromboaspiration was performed in all four patients using a 6F catheter. Recanalization was achieved in all patients and all arms were salvaged. Perforation of the small branch during guidewire manipulation was successfully managed by placement of a microcoil.

Conclusion: The combination of thrombolysis and thromboaspiration is effective for acute thromboembolic occlusion in the upper extremity.