Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia
Grip, O. ; Wanhainen, A. ; Acosta, S. LU
and Björck, M.
(2017)
In European Journal of Vascular and Endovascular Surgery
53(6).
p.853-861
- Abstract
Objectives: The purpose was to study long-term outcome after thrombolysis for acute arterial lower limb ischaemia, and to evaluate the results depending on the underlying aetiology of arterial occlusion. Methods: This was a retrospective study of patients entered into a prospective database. Patients were identified in prospective databases from two vascular centres, including a large number of variables. Case records were analysed retrospectively. Through cross linkage with the Population Registry 100% accurate survival data were obtained. Between January 2001 and December 2013, 689 procedures were included. The aetiology of ischaemia was graft/stent/stent graft occlusion in 39.8%, arterial thrombosis in 27.7%, embolus in 25.1% and... (More)
Objectives: The purpose was to study long-term outcome after thrombolysis for acute arterial lower limb ischaemia, and to evaluate the results depending on the underlying aetiology of arterial occlusion. Methods: This was a retrospective study of patients entered into a prospective database. Patients were identified in prospective databases from two vascular centres, including a large number of variables. Case records were analysed retrospectively. Through cross linkage with the Population Registry 100% accurate survival data were obtained. Between January 2001 and December 2013, 689 procedures were included. The aetiology of ischaemia was graft/stent/stent graft occlusion in 39.8%, arterial thrombosis in 27.7%, embolus in 25.1% and popliteal aneurysm in 7.4%. Results: The mean follow-up was 59.4 months (95% CI, 56.1-62.7), during which 32.9% needed further re-interventions, 16.4% underwent amputation without re-intervention, and 50.7% had no re-intervention. The need for re-intervention during follow-up was 48.0% in the graft/stent occlusions group, 34.0% of the popliteal aneurysm group, 25.4% in the thrombosis group, and 16.3% in the embolus group (p < .001). The overall primary patency rates were 69.1% and 55.9% at 1 and 5 years, respectively. Primary patency at 5 years was higher for the embolus group (83.3%, p = .002) and lower for the occluded graft/stent group (43.3%, p < .001). Secondary patency rates were 80.1% and 75.2% at 1 and 5 years, respectively, without difference between the subgroups. The amputation rate was lower in the embolic group at 1 and 5 years (8.1% and 11.1%, respectively, p = .001). Survival was higher in the group with occluded popliteal aneurysms at 5 years (83.3%, p = 0.004). Amputation free survival was 72.1% and 45.2% at 1 and 5 years; lower in the occluded graft/stent group at five years (37.9%, p = .007). Conclusion: Intra-arterial thrombolytic therapy achieves good medium and long-term clinical outcome, reducing the need of open surgical treatment in most patients.
(Less)
- author
- Grip, O.
; Wanhainen, A.
; Acosta, S.
LU
and Björck, M.
- organization
- publishing date
- 2017
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Acute limb ischaemia, Aetiological subgroups, Amputation free survival, Long-term follow-up, Long-term outcome, Thrombolysis
- in
- European Journal of Vascular and Endovascular Surgery
- volume
- 53
- issue
- 6
- pages
- 853 - 861
- publisher
- Elsevier
- external identifiers
-
- scopus:85014759839
- pmid:28291676
- pmid:28291676
- wos:000403518800018
- ISSN
- 1078-5884
- DOI
- 10.1016/j.ejvs.2017.02.003
- language
- English
- LU publication?
- yes
- id
- b3d93afa-fc9f-442c-8693-d20516877810
- date added to LUP
- 2017-04-10 16:01:02
- date last changed
- 2024-06-10 16:57:07
@article{b3d93afa-fc9f-442c-8693-d20516877810,
abstract = {{<p>Objectives: The purpose was to study long-term outcome after thrombolysis for acute arterial lower limb ischaemia, and to evaluate the results depending on the underlying aetiology of arterial occlusion. Methods: This was a retrospective study of patients entered into a prospective database. Patients were identified in prospective databases from two vascular centres, including a large number of variables. Case records were analysed retrospectively. Through cross linkage with the Population Registry 100% accurate survival data were obtained. Between January 2001 and December 2013, 689 procedures were included. The aetiology of ischaemia was graft/stent/stent graft occlusion in 39.8%, arterial thrombosis in 27.7%, embolus in 25.1% and popliteal aneurysm in 7.4%. Results: The mean follow-up was 59.4 months (95% CI, 56.1-62.7), during which 32.9% needed further re-interventions, 16.4% underwent amputation without re-intervention, and 50.7% had no re-intervention. The need for re-intervention during follow-up was 48.0% in the graft/stent occlusions group, 34.0% of the popliteal aneurysm group, 25.4% in the thrombosis group, and 16.3% in the embolus group (p < .001). The overall primary patency rates were 69.1% and 55.9% at 1 and 5 years, respectively. Primary patency at 5 years was higher for the embolus group (83.3%, p = .002) and lower for the occluded graft/stent group (43.3%, p < .001). Secondary patency rates were 80.1% and 75.2% at 1 and 5 years, respectively, without difference between the subgroups. The amputation rate was lower in the embolic group at 1 and 5 years (8.1% and 11.1%, respectively, p = .001). Survival was higher in the group with occluded popliteal aneurysms at 5 years (83.3%, p = 0.004). Amputation free survival was 72.1% and 45.2% at 1 and 5 years; lower in the occluded graft/stent group at five years (37.9%, p = .007). Conclusion: Intra-arterial thrombolytic therapy achieves good medium and long-term clinical outcome, reducing the need of open surgical treatment in most patients.</p>}},
author = {{Grip, O. and Wanhainen, A. and Acosta, S. and Björck, M.}},
issn = {{1078-5884}},
keywords = {{Acute limb ischaemia; Aetiological subgroups; Amputation free survival; Long-term follow-up; Long-term outcome; Thrombolysis}},
language = {{eng}},
number = {{6}},
pages = {{853--861}},
publisher = {{Elsevier}},
series = {{European Journal of Vascular and Endovascular Surgery}},
title = {{Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia}},
url = {{http://dx.doi.org/10.1016/j.ejvs.2017.02.003}},
doi = {{10.1016/j.ejvs.2017.02.003}},
volume = {{53}},
year = {{2017}},
}