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Peripheral thrombolysis for acute-onset claudication. Thrombolysis Study Group.
B D Braithwaite1, M A Tomlinson, S R Walker
1Queen's Medical Centr, Nottingham, UK.
The British Journal of Surgery
|June 26, 1999
Summary
Peripheral arterial thrombolysis for acute claudication showed similar outcomes to critical ischemia treatment. Observation is recommended, with thrombolysis reserved for cases progressing to critical ischemia.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Sudden onset incapacitating claudication of less than 2 weeks' duration.
- Peripheral arterial thrombolysis as a treatment option.
Purpose of the Study:
- Determine the outcome of patients with acute onset incapacitating claudication treated with peripheral arterial thrombolysis.
- Compare outcomes to thrombolysis for critical ischemia.
Main Methods:
- Retrospective search of the Thrombolysis Study Group database.
- Analysis of 108 patients treated with intra-arterial tissue plasminogen activator for acute-onset claudication.
- Categorization of occlusions into native vessel (56) and graft (52).
Main Results:
- High thrombus clearance rates for both native vessel (89%) and graft (92%) occlusions.
- Significant rates of secondary procedures (64% native, 52% graft).
- Similar 30-day outcomes including amputation (7-8%), mortality (14-13%), symptom freedom (68-62%), and persistent claudication (12-17%).
- Major hemorrhage occurred in 5-6% of patients.
Conclusions:
- Outcomes for acute claudication treated with thrombolysis resemble those for critical ischemia.
- Recommend observation for acute claudication, with thrombolysis reserved for progression to critical ischemia.