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The Journal of Cardiovascular Surgery 2020 Apr 01

DOI: 10.23736/S0021-9509.20.11121-2


lingua: Inglese

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 BOUDJELIT1, Alessia MOIA 1, Matthieu ARSICOT 1, Philippe TRESSON 1, Patrick LERMUSIAUX 1, 2, Antoine MILLION 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: Thrombolysis; Acute lower limb ischemia; Popliteal artery occlusion; Popliteal aneurysm; Popliteal artery entrapment

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