ORIGINAL ARTICLE  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2020 December;61(6):745-51

DOI: 10.23736/S0021-9509.20.11121-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Intra-arterial thrombolysis in acute popliteal artery occlusion is a safe and effective technique reducing the rate of open surgery

Nellie DELLA SCHIAVA ^{1, 2} ✉, Iris NAUDIN ^{1, 2}, Marine BORDET ^{1, 2}, Tarek BOUDJELIT ¹, Alessia MOIA ¹, Matthieu ARSICOT ¹, Philippe TRESSON ¹, Patrick LERMUSIAUX ^{1, 2}, Antoine MILLON ^{1, 2}

¹ Department of Vascular and Endovascular Surgery, University Hospital of Lyon, Lyon, France; ² University Claude Bernard Lyon 1, Lyon, France

BACKGROUND: Acute popliteal artery occlusion is a frequent clinical entity with a risk of major amputation. Several attitudes are possible and treatment is not standardized. The purpose of this study is to demonstrate safety and effectiveness of intra-arterial thrombolysis in acute popliteal artery occlusion.
METHODS: This is a retrospective analysis of a prospective database of patients treated by intra-arterial thrombolysis for acute lower-limb ischemia due to popliteal artery occlusion between 2001 and 2014.The primary endpoint was technical and clinical success. Etiologies and etiologic treatment, amputation-free survival, in-hospital mortality and bleeding complications rates were secondary endpoints.
RESULTS: Seventy-one patients, with a mean 6-day-old ischemic time before thrombolysis, were analyzed. Technical and clinical success was 90% and 87% respectively. Etiology was embolic in 33 patients (cardiac N.=14, aortic=6, unknown=13) and thrombotic in 38 (atheromatous N.=19, entrapment N.= 4, popliteal aneurysm N.=11, Buerger N.=2, thrombophilia N.=1, hyperhomocysteinemia N.=1). Survival and amputation-free survival at 30 days were 97% and 94% respectively. There were no major bleeding complications.
CONCLUSIONS: Intra-arterial thrombolysis of acute popliteal artery occlusion is an effective technique which reduces the rate of open surgery. The risk of bleeding complications is very low.

KEY WORDS: Thrombolytic therapy; Popliteal artery; Aneurysm