Thrombolytic therapy in peripheral arterial disease

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Peripheral arterial occlusion (PAO) is primarily caused by embolism and thrombosis.
• Surgical treatment for acute limb ischemia carries a significant 30-day mortality rate of 15%–25% due to complications.
• Intra-arterial thrombolysis is an established technique for lower extremity ischemia.

Purpose of the Study:

• To evaluate intra-arterial thrombolysis as an alternative to surgical revascularization for PAO.
• To compare the efficacy and safety of thrombolytic therapy versus traditional surgical interventions.
• To assess the potential benefits of thrombolysis in improving limb salvage rates.

Main Methods:

• Review of three prospective randomized trials (ROCHESTER, STILE, TOPAS) comparing thrombolysis with surgical revascularization.
• Analysis of data on patient outcomes, including need for subsequent surgery and limb salvage.
• Assessment of complication rates associated with intra-arterial thrombolysis, particularly bleeding events.

Main Results:

• Thrombolytic therapy, as an initial treatment, appears to reduce the risk of subsequent surgery for PAO.
• Improved limb salvage rates were observed in patients treated with thrombolysis.
• Severe bleeding, including a 1-2% risk of intracranial hemorrhage, is a notable complication.

Conclusions:

• Intra-arterial thrombolysis presents a viable alternative to surgery for selected PAO patients, potentially avoiding major surgical procedures.
• The technique allows for identification and subsequent treatment of underlying lesions via angioplasty, stenting, or elective surgery.
• While effective, the risk of severe bleeding necessitates careful patient selection and monitoring.