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Porcellini M., Cecere D., Carbone F., Bracale U. M., Di Lella D., Russo A., Del Guercio L., Bracale G. C.
Department of Vascular Surgery Federico II University, Naples, Italy
Aim. To evaluate the efficacy of intra-arterial thrombolysis and adjunctive endovascular procedures for infrainguinal native artery chronic occlusions, that result in a recent worsening of symptoms because of thrombosis superimposed on underlying pathologic lesions.
Methods. Intra-arterial catheter-directed thrombolysis with urokinase 300000 IU bolus followed by 70000 IU /h for 24-48 hours was administered to 54 patients affected with lower limb ischemia. Twenty-three patients (25 limbs) presented severe claudicatio and 31 patients (34 limbs) critical leg ischemia; subacute (14 days-3 months) symptoms were present in 60.9% and 77.4% , respectively. After successful thrombolysis, endovascular procedures (i.e., angioplasty, endoluminal stenting, endoprosthesis placement) were performed in 72% and 67.6%, respectively. In addition, infrainguinal autogenous vein reconstruction was performed in 5 patients with critical leg ischemia.
Results. Initial clinical improvement was seen in 76% of 25 extremities in group I, with a 30-day primary patency and relief of claudicatio in 68%. Arterial recanalization was achieved in 23 (67.6%) and restoration of flow in target vessels for subsequent bypass in 5 (14.7%) of 34 extremities in group II. The 30-day limb-salvage was 73.5%; limb loss included 2 amputations (5.9%) as a result of infection and/or necrosis in diabetic patients, despite anatomic patency at the endovascular procedure site. Relief of ischemia was achieved in 56% of claudicants (mean follow-up, 42 months) and limb salvage in 52.9% of patients with critical ischemia (mean follow-up, 36 months).
Conclusion. Thrombolysis and adjunctive endovascular procedures are an acceptable therapeutic option for the treatment of worsening manifestations of chronic occlusive disease of the femoropopliteal arterial segment.