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Update on intra-arterial thrombolysis in patients with lower limb ischemia.

Acosta, Stefan LU and Kuoppala, Monica LU (2015) In Journal of Cardiovascular Surgery 56(2). p.317-324
Abstract
Intra--arterial thrombolysis has become the most important minimal--invasive treatment option to treat acute lower limb ischemia. Although hemorrhagic stroke is a dreaded complication, it is considered beneficial to many fragile and elderly patients where vascular surgery is not an option. This review outlines current results after intra--arterial thrombolysis with low dose recombinant tissue plasminogen activator (rtPA) from 2001 to 2012 in two large vascular centers in Sweden. There was an increasing number of thrombolysis of occluded endoprosthesis and decreasing thrombolysis of occluded bypasses during this time period. Technical success rate for thrombolysis of occluded endoprosthesis, bypasses and native artery occlusion was 91%, 89%... (More)
Intra--arterial thrombolysis has become the most important minimal--invasive treatment option to treat acute lower limb ischemia. Although hemorrhagic stroke is a dreaded complication, it is considered beneficial to many fragile and elderly patients where vascular surgery is not an option. This review outlines current results after intra--arterial thrombolysis with low dose recombinant tissue plasminogen activator (rtPA) from 2001 to 2012 in two large vascular centers in Sweden. There was an increasing number of thrombolysis of occluded endoprosthesis and decreasing thrombolysis of occluded bypasses during this time period. Technical success rate for thrombolysis of occluded endoprosthesis, bypasses and native artery occlusion was 91%, 89% and 73%, respectively. Amputation--free survival rate at 1 year was 73%. Popliteal arterial aneurysm and anemia were independently associated with dismal amputation--free survival at 30 days. Independent factors associated with dismal amputation--free survival at long--term were foot ulcers, motor deficit, renal insufficiency and anemia. Major hemorrhage occurred in 104 procedures (13.9%); 43 (5.7%) were so severe that thrombolysis was discontinued in advance. All three (0.4%) hemorrhagic strokes were fatal. Preoperative severe limb ischemia with motor deficit was the only independent risk factor for major bleeding. Simultaneous heparin infusion was not associated with increased risk of major bleeding or improved leg salvage or survival. In conclusion, intra--arterial thrombolysis with rtPA for lower limb ischemia was effective, with few major bleeding complications. Simultaneous heparin infusion offered no advantage. Thrombolysis in embolism due to popliteal artery aneurysm is the most important step to improve run--off and a prerequisite to succeed with operative treatment. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Cardiovascular Surgery
volume
56
issue
2
pages
317 - 324
publisher
Edizioni Minerva Medica
external identifiers
  • pmid:25512316
  • wos:000353667200018
  • scopus:84938887020
ISSN
0021-9509
language
English
LU publication?
yes
id
813a6a22-9746-4c2d-adab-95c34887e7b1 (old id 4908192)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25512316?dopt=Abstract
date added to LUP
2015-01-08 15:15:36
date last changed
2017-11-05 04:12:57
@article{813a6a22-9746-4c2d-adab-95c34887e7b1,
  abstract     = {Intra--arterial thrombolysis has become the most important minimal--invasive treatment option to treat acute lower limb ischemia. Although hemorrhagic stroke is a dreaded complication, it is considered beneficial to many fragile and elderly patients where vascular surgery is not an option. This review outlines current results after intra--arterial thrombolysis with low dose recombinant tissue plasminogen activator (rtPA) from 2001 to 2012 in two large vascular centers in Sweden. There was an increasing number of thrombolysis of occluded endoprosthesis and decreasing thrombolysis of occluded bypasses during this time period. Technical success rate for thrombolysis of occluded endoprosthesis, bypasses and native artery occlusion was 91%, 89% and 73%, respectively. Amputation--free survival rate at 1 year was 73%. Popliteal arterial aneurysm and anemia were independently associated with dismal amputation--free survival at 30 days. Independent factors associated with dismal amputation--free survival at long--term were foot ulcers, motor deficit, renal insufficiency and anemia. Major hemorrhage occurred in 104 procedures (13.9%); 43 (5.7%) were so severe that thrombolysis was discontinued in advance. All three (0.4%) hemorrhagic strokes were fatal. Preoperative severe limb ischemia with motor deficit was the only independent risk factor for major bleeding. Simultaneous heparin infusion was not associated with increased risk of major bleeding or improved leg salvage or survival. In conclusion, intra--arterial thrombolysis with rtPA for lower limb ischemia was effective, with few major bleeding complications. Simultaneous heparin infusion offered no advantage. Thrombolysis in embolism due to popliteal artery aneurysm is the most important step to improve run--off and a prerequisite to succeed with operative treatment.},
  author       = {Acosta, Stefan and Kuoppala, Monica},
  issn         = {0021-9509},
  language     = {eng},
  number       = {2},
  pages        = {317--324},
  publisher    = {Edizioni Minerva Medica},
  series       = {Journal of Cardiovascular Surgery},
  title        = {Update on intra-arterial thrombolysis in patients with lower limb ischemia.},
  volume       = {56},
  year         = {2015},
}