Percutaneous treatment of acute multiple limb ischemia

This study evaluates the use of pulse spray pharmacomechanical thrombolysis (PSPMT) in combination with a low dose urokinase infusion and a possible secondary percutaneous treatment in the management of acute multiple limb ischemia. A retrospective analysis of 185 patients treated with PSPMT revealed eight patients with acute simultaneous ischemia of more than 1 limb. Seven patients presented with acute ischemia of both lower limbs; one patient presented with acute ischemia of the left arm and both lower limbs. All patients were treated using a combination of PSPMT and low dose urokinase infusion. The combination of PSPMT and low dose urokinase infusion was completely successful in 6 cases. In 1 patient with bronchogenic carcinoma PSPMT failed and immediate surgical thrombectomy was performed. In the other patient we obtained clot dissolution with thrombolysis in one leg, residual clots at the popliteal level in the other leg however had to be removed by surgical embolectomy. Embolism was the cause of the occlusion in 6 patients. Atherosclerotic disease appeared to be the underlying cause in the other 2 patients. Atherosclerotic disease was treated with balloon angioplasty and stenting. In the 8 patients with multiple limb ischemia, combination of PSPMT, low dose urokinase infusion, and possibly secondary treatment was useful and constituted a valuable alternative to open surgery. Acute occlusion of the abdominal aorta and acute leg ischemia have a high mortality and amputation rate with variable results in treatment. The use of thrombolysis has reduced the necessity of surgery in arterial occlusive disease and simplifies the treatment of native artery occlusion. Especially in patients with long and multi-level occlusions with poor outflow, thrombolysis seems to be the treatment of choice. In our analysis of 8 cases with acute multiple limb ischemia we review our experience with the combination of pulse spray pharmacomechanical thrombolysis (PSPMT), low dose continuous urokinase infusion and a possible subsequent percutaneous treatment of the obstructing lesion. The final purpose was to investigate if this combination is a successful and safe method in the treatment of acute multiple limb ischemia.