[Arterial occlusive disease. Catheter-directed thrombolytic therapy]

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Context:

• Thromboembolic occlusions in extremity arteries and bypass grafts pose significant clinical challenges.
• Catheter-directed thrombolysis presents a less invasive alternative to surgical revascularization for specific ischemia severities.

Purpose:

• To evaluate the efficacy and safety of local catheter-directed thrombolysis for peripheral arterial occlusions.
• To define the optimal therapeutic strategy, including patient selection and monitoring protocols, for this intervention.

Summary:

• Local catheter-directed thrombolysis is a viable option for extremity artery or bypass thromboembolic occlusions, demonstrating low complication rates.
• Successful treatment hinges on careful vascular team assessment, considering individual patient factors and contraindications.
• Intrathrombotic administration of fibrinolytic agents, precise dosing, and vigilant clinical and coagulation monitoring are crucial.
• Adjunctive therapies like mechanical thrombaspiration, balloon dilatation, or surgical correction may be employed as needed.

Impact:

• Provides a minimally invasive treatment pathway, potentially reducing morbidity associated with traditional surgical interventions.
• Highlights the importance of multidisciplinary vascular team decision-making for optimizing patient outcomes.
• Emphasizes the need for critical care resources and meticulous monitoring to ensure patient safety during thrombolysis.