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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
The Journal of Cardiovascular Surgery 2011 Agosto;52(4):467-76
Ultrasound-accelerated thrombolysis for lower extremity ischemia: multicenter experience and literature review
Schrijver A. M. 1, Vos J. A. 2, Hoksbergen A. W. J. 3, Fioole B 4., Fritschy W. M. 5, Hulsebos R. G. 6, De Jong S. C. 7, Reijnen M. M. P. J. 8, De Vries J.-P. P. M. 1 ✉
1 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands;
2 Department of Interventional Radiology; St. Antonius Hospital, Nieuwegein, The Netherlands;
3 Department of Vascular Surgery, Free University Medical Center, Amsterdam, The Netherlands;
4 Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands;
5 Department of Vascular Surgery, Isala Clinics, Zwolle, The Netherlands;
6 Department of Vascular Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands;
7 Department of Vascular Surgery, Beatrix Hospital, Gorinchem, The Netherlands
8 Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
AIM:This study evaluates the short-term outcome of ultrasound-accelerated thrombolysis in patients with lower extremity ischemia caused by thromboembolic occlusions.
METHODS: A retrospective cohort study was conducted from December 2008 to May 2011 of 57 patients (42 men; median age, 66±11 years) undergoing 62 episodes of ultrasound-accelerated thrombolysis for thromboembolic arterial occlusions of the lower extremities. The EKOS EndoWave System (EKOS Corporation, Bothell, WA, USA) was combined with urokinase (100000 IU/hour). Thirty-day and 6-month follow-up consisted of clinical evaluation, and Duplex scan or magnetic resonance angiography of the treated extremity.
RESULTS: Initial technical success was 97%, radiologic success was 82%, and overall clinical success was 77%. Median thrombolysis time was 21 hours (IQR, 15-24). In 38 of 51 procedures with successful lysis (75%) complete lysis was achieved within 24 hours. Major hemorrhage occurred in 2 procedures (3%), and distal embolization in 2 procedures (3%). During the initial hospitalization, the major amputation rate was 8% (N.=5) and the mortality rate was 2% (N.=1). The 30-day patency rate was 81%, without additional mortality. During a median 6-month (range, 2-14) follow-up, 9 reinterventions were performed. Two patients underwent major amputation and 3 patients died; because of malignancy (N.=2) and stroke (N.=1).
CONCLUSION: Initial success rates of ultrasound-accelerated thrombolysis are high and complication rate is low. However, reintervention rate during short-term follow-up for recurrent ischemia is substantial. Results from a randomized controlled trial comparing ultrasound-accelerated thrombolysis with standard thrombolysis for lower extremity ischemia (DUET, Current Controlled Trials, ISRCTN72676102) are eagerly awaited.