Use of Thrombolytics in Vascular and Endovascular Surgery

Until recently, acute arterial or venous thromboses were routinely managed with surgical intervention. With the development of effective thrombolytic pharmacologic agents and improved modes of delivery of these agents to the target site, surgery is no longer the only option. Greater understanding an...

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Bibliographic Details
Published in:Vascular 2008-03, Vol.16 (1_suppl), p.55-63
Main Authors: Weaver, Fred A., Lew, Wesley K.
Format: Article
Language:English
Subjects:
Combined Modality Therapy
Evidence-Based Medicine
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - adverse effects
Graft Occlusion, Vascular - therapy
Humans
Intracranial Thrombosis - therapy
Minimally Invasive Surgical Procedures
Thrombectomy - adverse effects
Thrombectomy - methods
Thrombolytic Therapy - adverse effects
Thrombosis - therapy
Treatment Outcome
Venous Thrombosis - therapy
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Summary:Until recently, acute arterial or venous thromboses were routinely managed with surgical intervention. With the development of effective thrombolytic pharmacologic agents and improved modes of delivery of these agents to the target site, surgery is no longer the only option. Greater understanding and knowledge about the finely orchestrated, counterbalanced processes of coagulation and fibrinolysis/thrombolysis have enabled development of agents and strategies for pharmacologic restoration of vascular patency while reducing or eliminating the need for surgery. An evidence-based rationale now exists for the use of thrombolysis in acute limb ischemia, deep venous thrombosis, stroke, and arteriovenous vascular access thromboses. Thrombolytic agents are valuable ancillary agents that allow a less invasive solution to a variety of thrombotic vascular conditions. Strategies that combine thrombolytic agents with endovascular techniques provide precise delivery of these drugs to the target thrombus. A more widespread adoption of this strategy has been limited primarily owing to problems with the currently available pharmacologic agents. The future of thrombolysis therapy is discussed in terms of data obtained from ongoing and recently completed clinical trials. Efforts to develop and study new thrombolytic agents that act directly on the thrombus without activation of intermediary biochemical steps will provide the next major step forward, as well as the rational basis for expansion of currently accepted indications for the treatment of acute arterial and venous thromboses.
ISSN:1708-5381
1708-539X
DOI:10.2310/6670.2008.1.00034