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Aggressive treatment of acute limb ischemia due to thrombosed popliteal aneurysms

Greenberg, R; Wellander, Erik; Nyman, Ulf LU ; Uher, P; Lindh, Mats LU ; Lindblad, Bengt LU and Ivancev, Krassi LU (1998) In European Journal of Radiology 28(3). p.211-218
Abstract
OBJECTIVE: The absence of infra-popliteal runoff in patients with acute limb ischemia and thrombosed popliteal aneurysms carries a high risk of amputation. A combined treatment method involving thrombolysis and surgery is reported. MATERIAL AND METHODS: Information regarding six patients was reviewed. Ankle brachial indices and degree of ischemia were recorded. All patients underwent digital subtraction angiography. In five patients thrombus dissolution was achieved using a combination of mechanical and pharmacologic therapy. One patient was judged incapable of withstanding any delay in reperfusion and was treated with isolated limb perfusion using a thrombolytic agent. All patients underwent surgical revascularization. Follow-up (1-3... (More)
OBJECTIVE: The absence of infra-popliteal runoff in patients with acute limb ischemia and thrombosed popliteal aneurysms carries a high risk of amputation. A combined treatment method involving thrombolysis and surgery is reported. MATERIAL AND METHODS: Information regarding six patients was reviewed. Ankle brachial indices and degree of ischemia were recorded. All patients underwent digital subtraction angiography. In five patients thrombus dissolution was achieved using a combination of mechanical and pharmacologic therapy. One patient was judged incapable of withstanding any delay in reperfusion and was treated with isolated limb perfusion using a thrombolytic agent. All patients underwent surgical revascularization. Follow-up (1-3 years) consisted of duplex examinations at 6 months and yearly thereafter. RESULTS: Five patients had no measurable ankle brachial index (ABI), while one patient had an ABI of 0.4. Initial angiography noted all patients to have no runoff in continuity to the pedal arch. Following thrombolytic therapy, an adequate bypass vessel was noted in all cases, with reconstitution of the plantar arch in five patients. Distal revascularizations included one peroneal, and five below knee popliteal arterial bypasses. Fasciotomies were performed in four of the six patients. There were no amputations. One patient developed a persistent foot drop. Two patients developed bypass grafts occlusions; one of which required therapy. CONCLUSION: The pre-operative use of thrombolytic therapy is a safe and effective method to achieve limb salvage in this patient population. Patients must be capable of withstanding an additional period of ischemia allowing for reconstitution of distal runoff. Isolated limb perfusion is of use when a delay to reperfusion cannot be tolerated. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Popliteal aneurysm, Thrombolysis, Isolated limb perfusion
in
European Journal of Radiology
volume
28
issue
3
pages
211 - 218
publisher
Elsevier
external identifiers
  • pmid:9881254
  • scopus:0032191993
ISSN
1872-7727
DOI
10.1016/S0720-048X(98)00117-X
language
English
LU publication?
yes
id
4e716ac2-34ad-48ec-bf8b-f4f98918efa5 (old id 1113585)
date added to LUP
2008-07-15 12:53:14
date last changed
2017-01-01 04:57:47
@article{4e716ac2-34ad-48ec-bf8b-f4f98918efa5,
  abstract     = {OBJECTIVE: The absence of infra-popliteal runoff in patients with acute limb ischemia and thrombosed popliteal aneurysms carries a high risk of amputation. A combined treatment method involving thrombolysis and surgery is reported. MATERIAL AND METHODS: Information regarding six patients was reviewed. Ankle brachial indices and degree of ischemia were recorded. All patients underwent digital subtraction angiography. In five patients thrombus dissolution was achieved using a combination of mechanical and pharmacologic therapy. One patient was judged incapable of withstanding any delay in reperfusion and was treated with isolated limb perfusion using a thrombolytic agent. All patients underwent surgical revascularization. Follow-up (1-3 years) consisted of duplex examinations at 6 months and yearly thereafter. RESULTS: Five patients had no measurable ankle brachial index (ABI), while one patient had an ABI of 0.4. Initial angiography noted all patients to have no runoff in continuity to the pedal arch. Following thrombolytic therapy, an adequate bypass vessel was noted in all cases, with reconstitution of the plantar arch in five patients. Distal revascularizations included one peroneal, and five below knee popliteal arterial bypasses. Fasciotomies were performed in four of the six patients. There were no amputations. One patient developed a persistent foot drop. Two patients developed bypass grafts occlusions; one of which required therapy. CONCLUSION: The pre-operative use of thrombolytic therapy is a safe and effective method to achieve limb salvage in this patient population. Patients must be capable of withstanding an additional period of ischemia allowing for reconstitution of distal runoff. Isolated limb perfusion is of use when a delay to reperfusion cannot be tolerated.},
  author       = {Greenberg, R and Wellander, Erik and Nyman, Ulf and Uher, P and Lindh, Mats and Lindblad, Bengt and Ivancev, Krassi},
  issn         = {1872-7727},
  keyword      = {Popliteal aneurysm,Thrombolysis,Isolated limb perfusion},
  language     = {eng},
  number       = {3},
  pages        = {211--218},
  publisher    = {Elsevier},
  series       = {European Journal of Radiology},
  title        = {Aggressive treatment of acute limb ischemia due to thrombosed popliteal aneurysms},
  url          = {http://dx.doi.org/10.1016/S0720-048X(98)00117-X},
  volume       = {28},
  year         = {1998},
}