Outcomes of Catheter-Directed Thrombolysis in Patients with Acute Arterial Thrombotic Limb Ischemia: A Prospective Interventional Case Series
Introduction: Acute limb ischemia is a critical medical condition that can quickly become a life threat. Therapeutic modalities such as catheter-directed thrombolysis (CDT) have demonstrated various levels of efficacy in previous studies. Objective: This study presents the descriptive findings of a series of cases who presented with acute arterial thrombotic limb ischemia and underwent CDT. Methods: This was a cross-sectional single-hospital-based case series, in which all patients who were diagnosed with acute arterial thrombotic limb ischemia, and consequently underwent CDT during the one-year study period were included. Detailed baseline characteristics and clinical findings of the studied patients on presentation, after intervention and at one-year follow-up are presented. Results: A total of 21 patients with a mean age of 60.7±15.2 years, including 16 males (76.2%) were included. The initial technical and treatment success rates were 20 (95.2%) and 14 (66.7%), respectively. The amputation-free and the overall survival rates after the one-year follow-up were 15 (71.4%) and 17 (81%), respectively. Four patients (19%) developed complications, two (9.5%) of which were significant (pulmonary hemorrhage and intraventricular hemorrhage). Amputation was performed in 6 (28.6%) cases. Conclusion: In this study, the treatment success rate and the technical success rate were satisfactory.
2. Wang JC, Kim AH, Kashyap VS. Open surgical or endovascular revascularization for acute limb ischemia. J Vasc Surg. 2016;63(1):270-8.
3. Kashyap VS, Gilani R, Bena JF, Bannazadeh M, Sarac TP. Endovascular therapy for acute limb ischemia. J Vasc Surg. 2011;53(2):340-6.
4. Hynes BG, Margey RJ, Ruggiero Ii N, Kiernan TJ, Rosenfield K, Jaff MR. Endovascular management of acute limb ischemia. Ann Vasc Surg. 2012;26(1):110-24.
5. Giannakakis S, Galyfos G, Sachmpazidis I, Kapasas K, Kerasidis S, Stamatatos I, et al. Thrombolysis in peripheral artery disease. Ther Adv Cardiovasc Dis. 2017;11(4):125-32.
6. Olinic D-M, Stanek A, Tătaru D-A, Homorodean C, Olinic M. Acute limb ischemia: an update on diagnosis and management. J Clin Med. 2019;8(8):1215.
7. Lyden SP. Endovascular treatment of acute limb ischemia: review of current plasminogen activators and mechanical thrombectomy devices. Perspect Vasc Surg Endovasc Ther. 2010;22(4):219-22.
8. de Athayde Soares R, Matielo MF, Neto FCB, Cury MVM, de Almeida RD, de Jesus Martins M, et al. Analysis of the results of endovascular and open surgical treatment of acute limb ischemia. J Vasc Surg. 2019;69(3):843-9.
9. Grip O, Kuoppala M, Acosta S, Wanhainen A, Åkeson J, Björck M. Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion. The Br J Surg. 2014;101(9):1105.
10. Darwood R, Berridge DC, Kessel DO, Robertson I, Forster R. Surgery versus thrombolysis for initial management of acute limb ischaemia. Cochrane Database Syst Rev. 2018;8(8):CD002784.
11. Berridge D, Kessel D, Robertson I. Surgery versus thrombolysis for acute limb ischaemia: initial management. Cochrane Database Syst Rev. 2002;(3):CD002784.
12. Morrison III HL, editor Catheter-directed thrombolysis for acute limb ischemia. Semin Intervent Radiol. 2006;23(3):258–69.
13. Lukasiewicz A, Lichota W, Thews M. Outcomes of accelerated catheter-directed thrombolysis in patients with acute arterial thrombosis. Vasc Med. 2016;21(5):453-8.
14. Schrijver AM, de Vries J-PP, van den Heuvel DA, Moll FL. Long-term outcomes of catheter-directed thrombolysis for acute lower extremity occlusions of native arteries and prosthetic bypass grafts. Ann Vasc Surg. 2016;31:134-42.
15. Limtungturakul S, Wongpraparut N, Pornratanarangsri S, Tresukosol D, Ruansetakit C, Mutirangura P, et al. Early experience of catheter directed thrombolysis for acute limb ischemia of native vessels and bypass graft thrombosis in Thai patients. J Med Assoc Thai. 2011;94(2):11-8.
16. Byrne RM, Taha AG, Avgerinos E, Marone LK, Makaroun MS, Chaer RA. Contemporary outcomes of endovascular interventions for acute limb ischemia. J Vasc Surg. 2014;59(4):988-95.
17. Schernthaner MB, Samuels S, Biegler P, Benenati JF, Uthoff H. Ultrasound-accelerated versus standard catheter-directed thrombolysis in 102 patients with acute and subacute limb ischemia. J Vasc Interv Radiol. 2014;25(8):1149-56.
18. Wongwanit C, Hahtapornsawan S, Chinsakchai K, Sermsathanasawadi N, Hongku K, Ruangsetakit C, et al. Catheter-directed thrombolysis for acute limb ischemia caused by native artery occlusion: an experience of a university hospital. J Med Assoc Thai. 2013;96(6):661-8.
19. Conrad MF, Shepard AD, Rubinfeld IS, Burke MW, Nypaver TJ, Reddy DJ, et al. Long-term results of catheter-directed thrombolysis to treat infrainguinal bypass graft occlusion: the urokinase era. J Vasc Surg. 2003;37(5):1009-16.
|Issue||Vol 5 No 3 (2021): Summer (July)|
|Amputation Ischemia Limb Salvage Mechanical Thrombolysis Thrombolytic Therapy|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|