Percutaneous isolated limb perfusion with thrombolytics for severe limb ischemia

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Thrombolytic Therapy

Background:

• Severe tibioperoneal disease often precludes distal bypass, leaving patients with limb-threatening ischemia facing limited revascularization options.
• Acute-on-chronic ischemia presents challenges, as prolonged systemic thrombolysis increases bleeding risks.
• Isolated limb perfusion offers a method to deliver higher thrombolytic doses with reduced systemic exposure.

Purpose of the Study:

• To evaluate the safety and efficacy of percutaneous isolated limb perfusion (ILP) using high-dose thrombolytics for severe limb ischemia.
• To assess limb salvage rates and symptomatic improvement in patients with no distal targets for conventional bypass.

Main Methods:

• Ten patients with severe limb ischemia underwent percutaneous ILP under anesthesia, with catheters placed in the brachial or popliteal artery and vein.
• A proximal tourniquet created an isolated limb circulation, allowing infusion of high-dose urokinase (500,000–1,000,000 U) for 45 minutes.
• Angiography, ankle-brachial index (ABI), and digital pressures were assessed pre- and post-procedure.

Main Results:

• Mean ABI improved from 0.15 to 0.5 in lower extremities; near-normal digital pressures were achieved in upper extremities.
• Marked clinical improvement was observed, with 90% limb salvage and symptomatic relief at 6 months.
• No bleeding complications occurred; one patient required postoperative anticoagulation.

Conclusions:

• Percutaneous isolated limb perfusion is a viable alternative for patients with severe limb ischemia and no revascularization options.
• This technique provides significant symptomatic relief and limb salvage, avoiding amputation.
• ILP enables targeted, high-dose thrombolysis with a favorable safety profile.