Home > Riviste > International Angiology > Fascicoli precedenti > International Angiology 2022 August;41(4) > International Angiology 2022 August;41(4):292-302

ULTIMO FASCICOLO
 

JOURNAL TOOLS

Opzioni di pubblicazione
eTOC
Per abbonarsi
Sottometti un articolo
Segnala alla tua biblioteca
 

ARTICLE TOOLS

Publication history
Estratti
Permessi
Per citare questo articolo
Share

 

ORIGINAL ARTICLE  PERIPHERAL ARTERIAL DISEASE 

International Angiology 2022 August;41(4):292-302

DOI: 10.23736/S0392-9590.22.04809-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Comparison of pharmaco-mechanical thrombolysis and catheter-directed thrombolysis for treating thrombotic or embolic arterial occlusion of the lower limb

Chun-Cheng WANG 1, 2, Chiung-Ray LU 2, Li-Chuan HSIEH 2, Chin-Chi KUO 1, 3, 4, 5, Pei-Wen HUANG 3, 5, Kuan-Cheng CHANG 1, 2, Chiz-Tzung CHANG 1, 4, Chung-Ho HSU 2

1 School of Medicine, China Medical University, Taichung, Taiwan; 2 Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; 3 Big Data Center, China Medical University Hospital, Taichung, Taiwan; 4 Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; 5 Department of Medical Research, China Medical University Hospital, Taichung, Taiwan



BACKGROUND: Whether pharmaco-mechanical thrombolysis (PMT) results in superior outcomes to catheter-directed thrombolysis (CDT) in treating thrombotic or embolic arterial occlusion of the lower limbs is unclear.
METHODS: We enrolled 94 patients with Rutherford class I-IIb due to thrombotic or embolic arterial occlusion in the lower limbs and who received emergency endovascular treatment. Baseline demographics, laboratory data, angiography and clinical outcomes were collected through chart reviews and fluoroscopic imaging. The procedural characteristics (thrombolytic drug dosage, treatment duration, and additional procedures), immediate angiographic outcomes (patency of calf vessels, and complete lysis), complications (major bleeding, and fasciotomy), and primary composite end-points (30-day mortality, amputation, and reocclusion) were compared between patients who received CDT versus PMT.
RESULTS: Compared with CDT, PMT was independently associated with lower total UK dosage (standardized coefficient β=- 0.44; P<0.01) and higher prevalence of complete lysis (odds ratio =1.78, 95% confidence interval: 1.03-3.06; P=0.04) after adjustments of covariates. The PMT group had significantly shorter treatment duration (23.00 [7.25-39.13] vs. 41.00 [27.00-52.50]; P<0.01). No significant intergroup differences were observed for the primary composite end point (10.7% vs. 9.1%; P=0.81), or prevalence of the major bleeding (9.1% vs. 0.0%; P=0.10) despite the PMT group comprising patients with more advanced chronic kidney disease and more diffuse thrombosis.
CONCLUSIONS: PMT with a Rotarex is a safe and effective strategy for treating thrombotic or embolic lower limb ischemia. It significantly reduced the thrombolytic drug dosage, and resulted in the complete lysis being more likely.


KEY WORDS: Ischemia; Extremities; Endovascular procedures; Amputation

inizio pagina