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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
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ORIGINAL ARTICLES VASCULAR SECTION
The Journal of Cardiovascular Surgery 2015 June;56(3):433-9
Catheter-directed thrombolysis for acute upper extremity ischemia
Schrijver A. M. 1, De Borst G. J. 1, Van Herwaarden J. A. 1, Vonken E. J. 2, Moll F. L. 1, Vos J. A. 3, De Vries J. P. 4 ✉
1 Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands;
2 Department of Interventional Radiology, University Medical Center Utrecht, Utrecht, the Netherlands;
3 Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands;
4 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
AIM: Acute nontraumatic upper extremity ischemia has significant chronic disability when not treated adequately and timely. As surgical treatment can be challenging, this study evaluates catheter-directed thrombolysis as first-line treatment for acute upper extremity ischemia.
METHODS: Between January 2006 and December 2010, 28 patients (22 women; mean age, 63±16 years) underwent catheter-directed thrombolysis for acute upper extremity ischemia, Rutherford class I or IIa. Proximal extent of the occlusion was in the subclavian (32%), axillary (7%), brachial (25%) and forearm arteries (36%). Median occlusion length was 18 cm (range, 12-43). Causes were embolus (14%), thrombus (39%), thoracic outlet syndrome (14%), paraneoplastic (4%), or unknown (29%).
RESULTS: Technical success was 96%, radiologic success (>95% clot lysis) 61%, and clinical success 68%. Median duration of thrombolysis was 24 hours (range, 18-96). Of the 11 radiologically unsuccessful patients (39%), five were treated conservatively and six underwent surgical intervention. In-hospital amputation-rate was 7%. Four complications occurred: embolization to the lower extremity, a transient ischemic attack, a subcapsular splenic hematoma and a pseudoaneurysm. Cumulative amputation-free survival at six months was 93%, standard error (SE) 4.87 and at one year 88%, SE 6.50.
CONCLUSION: These results show that catheter-directed thrombolysis is effective in over 60% of patients as first-line treatment of extensive acute upper extremity ischemia and can prevent surgical intervention in these patients.