CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES

Authors

  • Tiago Soares Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Universitário de S. João, Porto, Portugal
  • Paulo Dias Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Universitário de S. João, Porto, Portugal
  • Sérgio Sampaio Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Universitário de S. João, Porto, Portugal
  • José Teixeira Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Universitário de S. João, Porto, Portugal

DOI:

https://doi.org/10.48750/acv.455

Keywords:

catheter direct thrombolysis, acute limb ischaemia

Abstract

Introduction: Over the past few decades management options of the acute limb ischaemia (ALI) have changed. Nowadays, catheter direct thrombolysis (CDT) is commonly used as an alternative to surgery in immediate management of the ALI and may offer certain advantages over surgery in appropriately selected patients.

Objective: To evaluate CDT data for the treatment of acute ischaemia in lower extremity in different aetiologies.

Materials and methods: All consecutive patients who underwent CDT for acute limb ischaemia in our vascular surgery department, between 1 January 2011 to 31 August 2017 were identified and reviewed. Outcome measures included primary patency at 30 days and one year, haemorrhagic complications, major amputation and mortality.

Results: In total, 128 limbs from 106 patients were included. The median follow-up was 14 months [range: 6–31 months]. The aetiologies of ischaemia included in the study were native artery thrombosis, PTFE and GSV bypass thrombosis, intra-stent thrombosis, popliteal aneurysm and entrapment thrombosis and arterial embolism. The Stages of ALI according to the Rutherford classification were 12,5% in class I, 77,3% in class IIa and 10,2% in class IIb. Primary patency rates were 71.3% and 47.8% at one and three years, respectively. The requirement for re-intervention was 27.6% in the native artery thrombosis group, 65.2% in the PTFE graft thrombosis group, and 18.2% in the intra-stent thrombosis group. No re-interventions were verified for popliteal aneurysm or arterial embolism aetiologies. The overall amputation free survival was 83.3% at 27 months, and the cumulative incidence of death was 10.1% at 32 months. Complications occurred in 40 interventions (31.3%); the majority comprised minor bleeding from the access site, and one death due to haemorrhagic stroke.

Conclusions: CDT although associated with an increased risk of bleeding complications, it is a feasible and safe therapy, with clinical outcomes that may reduce the need for open surgical treatment in many patients. Our findings support this therapeutic approach as a valid option in ALI, in different aetiologies.

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References

Jivegard, L., J. Holm, and T. Schersten, Acute limb ischemia due to arterial embolism or thrombosis: influence of limb ischemia versus pre-existing cardiac disease on postoperative mortality rate. J Cardiovasc Surg (Torino), 1988. 29(1): p. 32-6.

Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial. Ann Surg, 1994. 220(3): p. 251-66; discussion 266-8.

Ouriel, K., et al., A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia. J Vasc Surg, 1994. 19(6): p. 1021-30.

Ouriel, K., F.J. Veith, and A.A. Sasahara, A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med, 1998. 338(16): p. 1105-11.

De Carvalho, J.S., S. Roncon ,R., Occlusion of prosthetic bypass. Experience of five consecutive years. Rev Port Cir Cardiotorac Vasc, 2013. 20(2): 93-7.

Kashyap, V.S., et al., Endovascular therapy for acute limb ischemia. J Vasc Surg, 2011. 53(2): p. 340-6.

Lokse Nilssen, G.A., et al., Results of catheter-directed endovascular thrombolytic treatment of acute ischaemia of the leg. Eur J Vasc Endovasc Surg, 2011. 41(1): p. 91-6.

Robertson, I., D.O. Kessel, and D.C. Berridge, Fibrinolytic agents for peripheral arterial occlusion. Cochrane Database Syst Rev, 2013(12): p. CD001099.

Theodoridis, P.G., et al., Thrombolysis in Acute Lower Limb Ischemia: Review of the Current Literature. Ann Vasc Surg, 2018. 52: p. 255-262.

Ebben, H.P., et al., Catheter Directed Thrombolysis Protocols for Peripheral Arterial Occlusions: a Systematic Review. Eur J Vasc Endovasc Surg, 2019. 57(5): p. 667-675.

Kuoppala, M., J. Akeson, and S. Acosta, Outcome after thrombolysis for occluded endoprosthesis, bypasses and native arteries in patients with lower limb ischemia. Thromb Res, 2014. 134(1): p. 23-8.

Grip, O., et al., Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia. Eur J Vasc Endovasc Surg, 2017. 53(6): p. 853-861.

Darwood, R., et al., Surgery versus thrombolysis for initial management of acute limb ischaemia. Cochrane Database Syst Rev, 2018. 8: p. CD002784.

Veenstra, E.B., et al., A systematic review and meta-analysis of endovascular and surgical revascularization techniques in acute limb ischemia. J Vasc Surg, 2020. 71(2): p. 654-668 e3.

Urbak, L., et al., Catheter-Directed Thrombolysis in the Treatment of Acute Ischemia in Lower Extremities Is Safe and Effec- tive, Especially with Concomitant Endovascular Treatment. Ann Vasc Dis, 2017. 10(2): p. 125-131.

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Published

2022-03-02

How to Cite

1.
Soares T, Dias P, Sampaio S, Teixeira J. CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES. Angiol Cir Vasc [Internet]. 2022 Mar. 2 [cited 2022 May 19];17(4):299-304. Available from: https://acvjournal.com/index.php/acv/article/view/455

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