Home > Riviste > The Journal of Cardiovascular Surgery > Fascicoli precedenti > The Journal of Cardiovascular Surgery 2002 December;43(6) > The Journal of Cardiovascular Surgery 2002 December;43(6):877-80

ULTIMO FASCICOLO
 

ARTICLE TOOLS

Estratti

THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632


eTOC

 

ORIGINAL ARTICLES  VASCULAR SECTION


The Journal of Cardiovascular Surgery 2002 December;43(6):877-80

lingua: Inglese

Intraoperative intra-arterial urokinase therapy after failed embolectomy in acute lower limb ischemia

Witz M. 1, Korzets Z. 2, Ellis M. 3, Shnaker A. 1, Lehmann J. 1

1 Vas­cular Sur­gery ­Unit,
2 Depart­ment of Neph­rology,
3 Divi­sion of Trans­fu­sion Med­i­cine,
Meir Gen­eral Hos­pital, ­Kfar ­Saba, affil­i­ated to Tel-­Aviv Uni­ver­sity ­Sackler School of Med­i­cine Tel-­Aviv, ­Israel


PDF  


Back­ground. Aim of ­this ­study is to eval­uate the use of intra­op­er­a­tive ­intra-arte­rial urok­i­nase infu­sion (­IIUI) in over­coming ­residual ­thrombi ­after throm­boem­bo­lec­tomy in ­acute ­lower ­limb ­ischemia.
­Methods. ­Design: ret­ro­spec­tive ­study ­over a 3-­year ­period. Set­ting: Uni­ver­sity affil­i­ated hos­pital. ­Patients: ­21 ­patients ­with ­acute ­lower ­limb ­ischemia who under­went ­IIUI ­after embo­lec­tomy (18 trans­fe­moral, 3 trans­pop­li­teal) had ­failed to ­achieve ade­quate ­distal per­fu­sion. Post­op­er­a­tively, all ­patients ­were main­tained on ­full ­dose hep­a­rin­iza­tion. ­Main out­come meas­ure­ments: com­plete or par­tial ­clot ­lysis on ­post-IIUI angio­graphy; res­to­ra­tion of ­pedal ­pulses and a ­viable leg at dis­charge.
­Results. Angio­graph­i­cally, com­plete and par­tial ­lysis was dem­on­strated in 14 and 3 ­patients, respec­tively. Two ­patients ­with pro­longed ­ischemia ­required fas­cio­tomy. One of ­these even­tu­ally had an ampu­ta­tion. Alto­gether, ­limb ampu­ta­tions (1 ­above ­knee, 2 ­below ­knee) ­were nec­es­sary in 3 ­patients. The angio­graphic appear­ance of ­lysis cor­re­lated ­well ­with the res­to­ra­tion of ­pedal ­pulses and/or ­limb ­viability. One ­patient ­died of myo­car­dial infarc­tion 3 ­days ­after the pro­ce­dure. Post­op­er­a­tively, ­there ­were 5 (24%) ­wound hemat­omas of ­which 1 ­required sur­gical explo­ra­tion. ­Over a ­mean ­follow-up ­period of 8 ­months (­range 1-16), ­limb sal­vage was sus­tained in the 17 ­patients ­with suc­cessful angio­graphic ­lysis.
Con­clu­sions. ­IIUI is an effec­tive ther­a­peutic ­adjunct to ­failed embo­lec­tomy in ­acute ­lower ­limb ­ischemia. Use of ­this pro­ce­dure is rec­om­mended as ­part of the rou­tine man­age­ment in ­such ­cases.

inizio pagina

Publication History

Per citare questo articolo

Corresponding author e-mail