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

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Łukawski K., Jeleńska M., Solonynko B., Kulisiewicz P., Szmidt J.
Polish Journal of Surgery
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2010
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vol. 82
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issue 6
337-340
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.
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