Catheter-Directed Thrombolysis in the Treatment of Acute Ischemia in Lower Extremities Is Safe and Effective, Especially with Concomitant Endovascular Treatment

Lærke Urbak, Louise de la Motte, Peter Rørdam, Aamir Siddiqi, Henrik Sillesen

Abstract

Objective : To evaluate the influence of pre-procedural characteristics on immediate and late results as well as the safety of catheter-directed thrombolysis (CDT) in acute ischemia of the lower extremity.Materials and Methods: A retrospective study comprising 249 patients treated by CDT from January 2006 to December 2012. Outcomes were primary patency, haemorrhagic complications, amputation and mortality.Results: Primary patency for CDT alone was 68%, for CDT plus endovascular treatment 87% and for successful CDT with supplementary surgery 62% giving an overall primary patency of 76%. Two (0.8%) patients suffered from cerebral haemorrhage during CDT. We found a significant correlation between 30 day amputation rate and no visual distal run-off at CDT start (OR 2.31; CI95% 1.09-4.91; p-value=0.02) and onset of symptoms to CDT start of 8-14 days (OR 4.09; CI95% 1.42-11.81; p-value=0.01). Lack of visualized distal run-off was also associated with a significant risk of 30 day mortality (OR 5.84; CI95% 1.26-27.00; p-value=0.02).Conclusion: Our results show that CDT is a feasible and safe treatment option especially when combined with angioplasty +/- stent. However, no distal run-off at primary angiography is associated with higher rates of amputation during follow-up and 30 day mortality.

OriginalsprogEngelsk
TidsskriftAnnals of vascular diseases
Vol/bind10
Udgave nummer2
Sider (fra-til)125-131
Antal sider7
ISSN1881-641X
DOI
StatusUdgivet - 25 jun. 2017

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