Thrombolysis
What is it?
A Procedure that removes or destroys
clots
 Preformed in a Angio suit
 Many times both a Radiologist and a
Vascular surgeon
 Most common reason for during procedure
is {peripheral Arterial Occlusive Disease

Techniques
Introduction of catheter into the Femoral
Artery
 Catheter Advanced to the clot site
 Different Drugs are administered to the
site
 Streptokinase, Urokinase, or rtPA

Techniques
Catheter placement in Femoral Artery
Techniques
Local Low Dose Thrombolysis
 Discovered by Dotter in 1974
 Less hazardous treatment
 More efficient
 Pharmaceutical - Streptokinase

Techniques
Local Low-Dose
Unlike other techniques at the time the
dose is reduced to 1/20 the size
 Very popular in treating ilio-femoral
Thrombosuses

Techniques
Local Low-Dose
Advantages
 Pure drug right to thrombus
 Protection of lytic agents from antibodies
and inhibitors
 Loading dose not necessary
 Shorter infusion time
 Less costly

Techniques
Local Low-Dose
Techniques
Urokinase Infusion
This technique is most used for patients
with low risk of tissue infarction
 Catheter is placed in the affected artery
 Tip is placed 5 to 10mm from clot site
 Urokinase is infused at a rate of 60 ml/hr
 Patient is brought back to department
every 4 to 8 hours to check Clot Lysis

Techniques
McNamara Infusion
The procedure again uses the placement
of catheters to the clot site
 This procedure is specially used for
patients at high risk for Limb or Organ
lose
 Much like the Low-Dose technique but,
infusion rate is quadrupled for first 6 hours

Techniques
McNamara Infusion
Once clot shows signs of dissolving then
rate is slowed to that of the Low-Dose
technique
 If clot does not show any signs of
breaking down the patients will often be
sent to surgery to have organ or limb
removed

Techniques
Hess
Catheter is advanced to the clot site
 Either Streptokinase or Urokinase can be
used
 A hand injected method is used
 1 to 3 ml is given every 5 minutes

Techniques
Hess
Advantages
 Operator is able to view clot breaking
down under fluoroscopy, chase clot as it
moves
 Operator has full control of when drug is
administered
 Shorter procedure
