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The current role of intra-arterial thrombolysis
T Richards1, A A Pittathankal, T R Magee
1Vascular Unit, Department of Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, U.K.
Background:
the role of intra arterial thrombolysis (IAT) in the management of peripheral vascular disease has come under scrutiny. This study aims to assess current usage and indications for IAT in the U.K.
Method:
the use of IAT was assessed at our own centre and a questionnaire was sent to all centres that provide data for the U.K. "Thrombolysis Study Group".
Results:
there has been a steady decline in the use of IAT at our centre from a peak of 40 cases per annum to zero. Response was received from 22 of 24 centres (92%). Nineteen (86%) reported a decline in IAT use. Main reasons were concerns over lack of efficacy (74%) and complication rate (63%). Most centres would use IAT for acute limb ischaemia (86%). However, for acute thrombosis in specific indications the results varied; synthetic graft (82%), vein graft (54%), supra-inguinal graft (54%) and thrombosed popliteal artery aneurysm (54%). When asked what their commonest usage for IAT was, the results again varied; acute limb ischaemia (40%), graft thrombosis (40%), embolism post radiological intervention (12%), other (8%).
Conclusion:
there has been a significant decrease in IAT use. Concerns exist as to efficacy and complication rate. There is no clear consensus on indications.