Evans, James A.
May 1961
Angiology;May1961, Vol. 12 Issue 5, p155
Academic Journal
It is difficult to explain why massive edema persists in case 5 when the venogram shows such rapid clearance of the opaque material through the venous system of the arm, except that the edema may be on the basis of persistent lymphatic blockade. This patient did not have evidence of malignant disease in the axilla or chest 4 months after operation. In our experience x-ray therapy has not produced fibrosis to account for persistent lymphedema. She did have thrombosis in the subclavian vein with great response of the collateral circulation and a massively swollen arm from the beginning, and probably had massive lymphangitis in the sheaths of many veins. The average age of the clot when the venous channel was not cleared successfully was 16+ days; the average age in the successful cases was 8.2 days. The effect of pyrogenic reaction in the dissolution of clots is known, but 2 of our successfully treated patients who received a pyrogen-free lot had no febrile reaction. In 3 of the successful cases, the pyrogenic reaction was severe with high fever, abdominal pain and vomiting. The small doses of fibrinolysin (25,000 and 50,000 units) that were effective in eases 2 and 3 suggest that the severe pyrogenic reaction was the mechanism in these 2 patients. In 1 of our 5 successful cases the obstructed vein cleared without the simultaneous administration of other anticoagulants. In case 1, a relapse 1 week after clearing does not suggest that this patient's own fibrinolysin mechanism could have been stimulated by streptokinase in the fibrinolysin solution to keep the clot dissolved. She received a moderately large dose of 250,000 units. A venous channel cleared in only 1 of 13 patients on acenocoumarol therapy whereas in 5 of 10 patients on fibrinolysin therapy the channel cleared, as proved by venogram. Whatever the mechanism of intravascular dissolution of the clot may be, from the clinician's point of view, fibrinolysin does seem to be an effective agent. It is not desirable to effect this action by pyrogens, however, and in 2 cases this was not the mechanism.


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