[Low-dose thrombolysis using rt-Pa in extensive peripheral vascular occlusion]

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Thrombolytic Therapy

Background:

• Peripheral vascular occlusion presents a significant challenge in vascular surgery.
• Existing treatments for extensive occlusions often carry substantial risks and limited efficacy.
• Intra-arterial thrombolysis offers a potential minimally invasive approach.

Purpose of the Study:

• To assess the effectiveness of intra-arterial thrombolysis using recombinant tissue plasminogen activator (rt-PA).
• To evaluate rt-PA efficacy in treating acute and subacute extensive peripheral arterial occlusions.
• To determine the success rate and complication profile of this treatment modality.

Main Methods:

• 100 patients with extensive acute/subacute peripheral artery or bypass occlusion underwent catheter-directed thrombolysis.
• A low dose of rt-PA (20 mg over 20-24 hours) was infused intra-arterially, alongside heparin.
• Angiography guided thrombolysis, followed by percutaneous transluminal angioplasty (PTA) or thrombectomy if needed.

Main Results:

• Successful recanalization was achieved in 85% of original vessels and 65% of bypass vessels.
• Thrombolysis helped avoid amputation in 13/15 patients with critical ischemia by reopening collateral arteries.
• Minor bleeding at the puncture site was the primary complication; no major intracranial or retroperitoneal bleeding occurred.

Conclusions:

• Low-dose rt-PA thrombolysis is a safe and effective treatment for extensive peripheral artery and bypass occlusions.
• The procedure demonstrates a low complication rate and high success in restoring vascular patency.
• Even partial recanalization can significantly improve outcomes and prevent limb amputation.