Assessment of Early Results of Fibrinolytic Treatment of Acute Ischemia of the Lower Limbs

• Authors: Krzysztof Łukawski , Maria Jeleńska , Bohdan Solonynko , Piotr Kulisiewicz , Jacek Szmidt
• Languages of publication: EN

Abstracts

EN

Acute ischemia of lower limbs due to thrombosis of large arteries is associated with high mortality and high rate of dangerous complications. Isolated intraarterial thrombolysis may improve prognosis of patients at high operative risk.The aim of the study was to assess early results of local thrombolytic therapy (recombinant tissue plasminogen activator r-tPA) of acute ischemia of lower limbs (duration of ischemia up to 15 days) in patients with poor general condition and with a history of vascular operations.Material and methods. Local intraarterial thrombolysis was performed in 35 patients who had developed acute ischemia of lower limbs due to thrombosis, in Chair and Clinic of General, Vascular and Transplantation Surgery, Warsaw Medical University in the period of time between 2003 and 2006. Twenty six of these patients previously underwent implantation of grafts made of artificial material. Signs and symptoms of ischemia persisted from several hours to 15 days. Nine patients were classified as ASA-IV, 26 patients as ASA-III on the risk scale.Thrombolytic therapy involved local infusion of recombinant tissue plasminogen activator r-tPA (Actylise) through a catheter inserted into the common femoral artery (contralateral to the ischemic limb). When thrombolysis was completed, heparin (given at a prophylactic dose) was started and continued until discharge.Results. Thrombolytic therapy resulted in vessel patency in 18 out of 35 treated patients (51%). Treatment effectiveness increased with shortening of duration of the limb ischemia. During thrombolytic therapy, one patient developed gastrointestinal bleeding that despite treatment resulted in death. In ten treated patients local bleeding from the puncture site was found, treated with compression in 9 patients while one patient required surgical intervention (evacuation of hematoma). Neither death nor limb amputation occurred during the hospitalization of 18 patients after the successful thrombolysis. Three patients required angioplasty due to vascular stenoses found in angiography as the cause of thrombosis. After unsuccessful thrombolysis, necrosis of peripheral parts of the limbs occurred and due to lack of possibility of further vascular reconstruction, amputation was required. Surgical restoration of vessel patency performed in the remaining 12 patients was successful in eight patients, while unsuccessful in the other 4 patients who also required limb amputation. Three deaths occurred in this group, caused by heart failure after the procedure of restoration of vessel patency.Conclusions. Our results indicate that local thrombolytic therapy can be effective in rescuing a limb at risk in patients with contraindications to surgical treatment.

Keywords

EN

fibrinolytic treatment; acute ischemia of the lower limbs

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2010
• Volume: 82
• Issue: 6
• Pages: 337-340

Dates

published

1 - 6 - 2010

online

15 - 9 - 2010

Contributors

author

Krzysztof Łukawski

• Chair and Clinic of General, Vascular and Transplantation Surgery, Warsaw Medical University

author

Maria Jeleńska

• Chair and Clinic of General, Vascular and Transplantation Surgery, Warsaw Medical University

author

Bohdan Solonynko

• Chair and Clinic of General, Vascular and Transplantation Surgery, Warsaw Medical University

author

Piotr Kulisiewicz

• Department of Clinical Radiology, Warsaw Medical University

author

Jacek Szmidt

• Chair and Clinic of General, Vascular and Transplantation Surgery, Warsaw Medical University

References

• Dormandy JA, Rutherford RB: Management of peripheral arterial disease. TASC Working Group. J Vasc Surg 2000; 31: 1-296
• Ouriel K, Shortell CK, DeWeese JA et al.: A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia. J Vasc Surg 1994;19: 1021-30.[PubMed][Crossref]
• Hall TB, Matson M, Belli AM: Thrombolysis In the peripheral vascular system. Eur Radiol 2001; 11: 439-45.[PubMed][Crossref]
• Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33: Supplement 1.[WoS]
• Berridge DC, Kessel DO, Robertson I: Surgery versus thrombolysis for initial management of acute limb ischaemia: The Cochrane Collaboration Issue 4, 2009.
• Korn P, Khilinani NM, Fellers JC et al.: Thrombolysis for native arterial occlusion of lower extremities: clinical outcome and cost. Vasc Surg 2001; 33: 1148-57.[Crossref]
• Ouriel K, Veith F, Sahara AA: compression of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med 1998; 338: 1105-11.

Identifiers

DOI

10.2478/v10035-010-0048-3