ORIGINAL ARTICLES   

Italian Journal of Vascular and Endovascular Surgery 2004 June;11(2):65-72

Copyright © 2005 EDIZIONI MINERVA MEDICA

lingua: Inglese

Thrombolysis and endovascular procedures for the treatment of infrainguinal chronic arterial occlusions

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.