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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2017 Aug 29

DOI: 10.23736/S0021-9509.17.10023-6


lingua: Inglese

Catheter directed thrombolysis is not limited to acute limb ischemia treatment- the experience from vascular surgery division

Aleksander LUKASIEWICZ 1 , Piotr FLISINSKI 1, 2, Wojciech LICHOTA 1

1 Department of Vascular Surgery, Regional Specialty Hospital, Grudziadz, Poland; 2 Department of Normal Anatomy, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland


BACKGROUND: Thrombolytic treatment has many potential indications in the era of modern vascular surgery. We aimed to analyze the contemporary experience in the catheter-directed, intraarterial thrombolysis in different clinical scenarios.
METHODS: The available data of 121 patients with different types (acute, subacute, complications of vascular procedures) of lower limb ischemia treated by means of the intraarterial, catheter- directed thrombolysis between 11.2011 and 12.2016 were retrospectively analyzed. The basic treatment protocol, utilized in 92% of patients, was a catheter-directed infusion of 40 mg of alteplase within 3.5 hours. Pre- and intraprocedural factors (indications, demographic details, comorbidities, the dose of alteplase utilized, underlying lesions procedures), as well as postoperative outcomes (lysis grade, death, complications, reinterventions, and limb loss after 1- month observation), were analyzed.
RESULTS: Successful thrombolysis was achieved in 76.1% (92 out of 121) patients. The success rate was similar for acute, subacute limb ischemia and thrombotic complications of vascular procedures. 67.8% (82 patients) had procedures to correct underlying lesions performed. Overall complication rate was 28.1% however, but the major bleeding was observed in only 5% (6 patients). Neither intracranial bleeding nor gastrointestinal bleeding occurred. No mortality, 1,7% reintervention rate and 10,7% amputation rate were recorded during one-month follow-up.
CONCLUSIONS: Accelerated intraarterial thrombolysis is an effective measure in the treatment of acute, sub-acute limb ischemia as well as thromboembolic complications of vascular procedures. It carries a low risk of major bleeding. The location of thrombus in the crural arteries adversely affects the treatment results. Atrial fibrillation increases the risk of amputation while complete thrombus lysis is protective.

KEY WORDS: Thrombolysis - Limb ischemia - Endovascular - Complications

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Publication History

Article first published online: August 29, 2017
Manuscript accepted: August 28, 2017
Manuscript revised: July 11, 2017
Manuscript received: May 7, 2017

Per citare questo articolo

Lukasiewicz A, Flisinski P, Lichota W. Catheter directed thrombolysis is not limited to acute limb ischemia treatment- the experience from vascular surgery division.. J Cardiovasc Surg 2017 Aug 29. DOI: 10.23736/S0021-9509.17.10023-6

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