Outcomes and Complications after Intraarterial Thrombolysis for Limb Ischemia: a 4 Year Study at a Single Centre

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Introduction. The reason for using thrombolytic therapy is to eliminate vascular thrombosis and promote vascular permeability. Acute limb ischemia is associated with significant morbidity and mortality. ROCHESTER, STILE and TOPAS studies showed that thrombolytic therapy for acute limb ischemia decreases the rate of surgical interventions and significantly increases the rate of limb salvage.

Aim of the Study. The purpose of this study is to assess the efficacy and outcomes of intra-arterial thrombolysis in the treatment of acute occlusions of the lower limb over a four-year period.

Material and Methods. We analysed 103 patients who had been treated in our department. There were acute ischemias of stage IIa and IIb according to the Rutherford classification. The data prior to, and after thrombolysis was analysed. We used Alteplase as a thrombolytic agent (mean dose 62 mg ±23.5). Procedural success was based on angiographic and clinical outcomes. Statistics were calculated by SPSS 16.

Results. The mean duration of symptoms prior to hospitalisation was 2.5 days (IQR 5-96 hours). The mean age at the time of thrombolysis was 63±11 for males 69±10 years for females. The success of intraarterial thrombolysis was defined by angiographic and clinical outcomes (successful in 86.4% and failed in 13.6%). Adjunctive angioplasty was performed on 39 (37.9%) patients, and immediate reconstructive surgery was required on 19 (18.4%) patients. The incidence of complications was 17,4 %, with the most common being-bleeding from the puncture side, the urinary tract or the gastrointestinal tract. Overall mortality was 8.7%. The women who required thrombolysis were older (p=0,034) and with a higher death rate (p=0.047). A CDT (catheter-directed thrombolysis) for an abdominal aorta thrombosis carries a significantly high mortality rate (p=0.00013). There were no statistically significant differences between the duration of symptoms and limb amputation and between other analysed data.

Conclusions. Intraarterial thrombolysis is an effective treatment method in acute limb ischemia for selected patients, as long as accurate procedural monitoring is ensured. Thrombolysis often leads to the discovery of underlying vascular lesions. A CDT for an abdominal aorta thrombosis carries a significantly high mortality rate.

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Acta Chirurgica Latviensis

The Journal of Riga Stradins University; Latvian Association of Surgeons; Latvian Association of Paediatric Surgeons

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