Peripheral thrombolysis for acute-onset claudication B. D. Braithwaite, M. A. Tomlinson*, S. R. Walker², B. Davies², T. M. Buckenham* and J. J. Earnshaw² on behalf of the Thrombolysis Study Group Queen's Medical Centre, Nottingham, *St George's Hospital, London and ²Gloucestershire Royal Hospital, Gloucester, UK Correspondence to: Mr B. D. Braithwaite, King's Mill Hospital, Mans®eld Road, Sutton-in-Ash®eld NG17 4JL, UK Background: The aim of this study was to determine the outcome of patients who presented with sud- den onset of incapacitating claudication of less than 2 weeks' duration and who were treated with per- ipheral arterial thrombolysis. Methods: The database of the Thrombolysis Study Group was searched retrospectively for patients who received thrombolysis for acute-onset claudication. Some 108 patients (65 men, median age 69 (range 29±94) years) were treated with intra-arterial tissue plasminogen activator at 14 hospitals. The median duration of symptoms was 72 h (range from 2 h to 2 weeks). There were 52 graft and 56 native vessel arterial occlusions. Results: The immediate outcome of thrombolysis for native vessel arterial occlusion was thrombus clearance in 50 patients (89 per cent) and failed lysis in six (11 per cent). Thirty-six patients (64 per cent) had a secondary radiological or surgical procedure carried out after lysis. After 30 days four patients (7 per cent) had a major amputation, eight (14 per cent) had died, 38 (68 per cent) were symptom free and seven (12 per cent) continued to have claudication. Three patients (5 per cent) suffered a major haemor- rhage. The immediate outcome of thrombolysis for graft occlusion was thrombus clearance in 48 pa- tients (92 per cent) and failed lysis in four (8 per cent); 27 patients (52 per cent) had a secondary procedure. After 30 days four patients (8 per cent) had a major amputation, seven (13 per cent) had died, 32 (62 per cent) were symptom free and nine (17 per cent) had persistent claudication. Three patients (6 per cent) suffered a major haemorrhage. Conclusion: Patients who presented with acute onset of incapacitating claudication had an outcome similar to that after thrombolysis for critical ischaemia. It is recommended that patients who present in this way should be observed and treated with thrombolysis only if they progress to critical ischaemia. Presented to the Association of Surgeons of Great Britain and Ireland, Edinburgh, UK, May 1998, and published in abstract form as Br J Surg 1998; 85(Suppl 1): 24 Paper accepted 22 February 1999 British Journal of Surgery 1999, 86, 800±804 Introduction Peripheral intra-arterial thrombolysis is a useful technique in the management of acute critical limb ischaemia. It is not without risk. Some 10 per cent of patients may suffer haemorrhage which requires blood transfusion, may need an operation to stop bleeding or may die from bleeding 1,2 . Two per cent of patients suffer a stroke and half of the strokes that occur are related to treatment 3 . Chronic intermittent claudication may be regarded as benign, as the associated annual rates of amputation, intervention for critical limb ischaemia and all causes of death are 1´6, 5´6 and 4´3 per cent respectively 4 . The use of peripheral thrombolysis in the management of an arterial occlusion that results in the sudden onset or worsening of claudication might be questioned when the risks of treatment are balanced with the natural history of the disease. The aim of this study was to determine the outcome for patients who presented with a sudden onset of incapacitat- ing claudication and were treated with peripheral arterial thrombolysis within 2 weeks of the onset of symptoms. Patients and methods A national database of peripheral thrombolysis has been collected since 1992 with the aim of conducting audit and research on thrombolytic therapy 5 . Fourteen hospitals with a special interest in lysis have submitted clinical details to a central database, from which all members can obtain data. The data represent a selected group, not a consecutive Original article 800 British Journal of Surgery 1999, 86, 800±804 ã 1999 Blackwell Science Ltd