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Surgery versus thrombolysis for acute limb ischaemia: initial management
The Cochrane Database of Systematic Reviews
|October 18, 2000
Summary
Choosing between surgery and thrombolysis for acute limb ischemia depends on lesion duration. While thrombolysis may improve survival for acute lesions, surgery might be better for native vessel issues, with no overall one-year difference in limb salvage.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Interventions
Background:
- Peripheral arterial thrombolysis is an established adjunct for managing peripheral arterial ischemia.
- Optimal initial management for acute limb ischemia requires further determination.
- Randomized controlled trial data on thrombolysis versus surgery is limited.
Purpose of the Study:
- To compare the effectiveness of surgery versus thrombolysis as the initial treatment for acute limb ischemia.
Main Methods:
- Systematic review of randomized controlled studies comparing thrombolysis and surgery for acute limb ischemia.
- Data extraction and quality assessment performed independently by three reviewers.
Main Results:
- Thrombolysis showed increased survival at one year for acute lesions (<7 days) compared to surgery, with fewer cardiopulmonary complications.
- Initial thrombolysis reduced amputation and death rates at six months for lesions <14 days.
- However, surgery demonstrated better outcomes for native vessel thromboses at one year, and thrombolysis of thrombosed grafts was associated with higher rates of ongoing ischemia.
Conclusions:
- No universal initial treatment (surgery or thrombolysis) is recommended for acute limb ischemia based on current evidence.
- Overall limb salvage and mortality at one year are similar between initial surgery and thrombolysis.
- Thrombolysis may increase risks of ongoing limb ischemia and hemorrhagic complications, necessitating a balance against surgical risks for individual patients.