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Surgery versus thrombolysis for acute limb ischaemia: initial management
D C Berridge1, D Kessel, I Robertson
1Department of Vascular and Endovascular Surgery, St James's University Hospital, Beckett Street, Leeds, Yorkshire, UK, LS9 7TF. David Berridge@GW.SJSUH.NORTHY.NHS.UK
The Cochrane Database of Systematic Reviews
|July 26, 2002
Summary
For acute limb ischaemia, initial surgery and thrombolysis show similar limb salvage and survival rates. However, thrombolysis increases risks of stroke and major bleeding.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Peripheral arterial thrombolysis is a key treatment for peripheral arterial ischaemia.
- Limited randomized controlled trial data exist on its efficacy compared to surgery for acute limb ischaemia.
Purpose of the Study:
- To compare the effectiveness of initial surgery versus thrombolysis for acute limb ischaemia.
Main Methods:
- Systematic review of randomized controlled trials comparing initial thrombolysis and surgery.
- Searched Cochrane Controlled Trials Register, specialized registers, and conference proceedings.
- Independent data extraction and quality assessment by reviewers.
Main Results:
- Five trials (1,283 patients) found no significant difference in limb salvage or death at one year.
- Initial thrombolysis was associated with higher rates of stroke, major hemorrhage, and distal embolization.
- Patients receiving initial thrombolysis underwent less severe interventions.
Conclusions:
- Neither surgery nor thrombolysis is universally preferred for initial acute limb ischaemia treatment.
- Thrombolysis carries increased risks of hemorrhagic complications (including stroke) and ongoing limb ischaemia.
- Individual patient risks must be weighed against surgical risks.