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Late results of local thrombolytic treatment of peripheral arterial occlusions
P Poredos1, D Keber, V Videcnik
1Trnovo Hospital, University Clinical Center, Ljubljana, Yugoslavia.
Insights
Low-dose intraarterial streptokinase effectively treated acute and subacute lower limb arterial occlusions. Successful recanalization, often combined with percutaneous transluminal angioplasty, achieved a 63.4% five-year patency rate.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Thrombolytic Therapy
Background:
- Acute and subacute arterial occlusions of lower limbs pose significant challenges, often leading to amputation.
- Traditional treatments like bypass surgery may not be suitable for all patients due to comorbidities or poor runoff.
- Intraarterial thrombolysis offers a potential alternative for limb salvage.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of low-dose intraarterial streptokinase for acute and subacute lower limb arterial occlusions.
- To assess the impact of percutaneous transluminal angioplasty (PTA) in conjunction with thrombolysis.
- To identify factors influencing reocclusion rates and long-term patency.
Main Methods:
- A cohort of 134 patients with acute/subacute lower limb arterial occlusions were treated with low-dose intraarterial streptokinase.
- Observation periods extended up to five years.
- Percutaneous transluminal angioplasty (PTA) was performed in 45% of patients with successful recanalization.
Main Results:
- Primary recanalization was achieved in 66 patients (49.3%).
- The cumulative patency rate after five years was 63.4%.
- Reocclusion was highest in the first year (17.4%), with a yearly rate of 4-9% thereafter. Factors like atherosclerotic severity, runoff status, and diabetes mellitus influenced outcomes. Unsuccessful recanalization led to amputation in 61.7% of patients.
Conclusions:
- Low-dose intraarterial streptokinase, especially when combined with PTA for residual stenosis, is an effective treatment for acute and subacute arterial occlusions in carefully selected patients.
- The treatment offers a viable limb salvage option for patients unsuitable for bypass surgery.
- Long-term patency is influenced by the extent of atherosclerosis, runoff vessel quality, and the presence of diabetes mellitus.
Abstract:
One hundred thirty-four patients, in whom acute and subacute arterial occlusions of lower limbs were treated with low dose intraarterial streptokinase, were observed for periods of up to five years. Primary recanalization of occluded vessels was achieved in 66 patients, but in the remaining 68 patients recanalization was not observed. In 45% of the patients with successful thrombolytic treatment, percutaneous dilatation (PTA) of remnant stenosis was performed. In patients with successful recanalization the reocclusion rate was greatest in the first year (17.4%); the first two weeks after therapy were most critical in this respect. The reocclusion rate during the succeeding years ranged from 4% to 9% per year. The cumulative patency rate after five years was 63.4%. Late results were better in patients in whom more proximal vascular segments were affected. The preservation of vessel patency was highly dependent on the severity and extent of the previous atherosclerotic process and especially on the state of peripheral (runoff) arteries. Presence of diabetes mellitus increased the reocclusion rate of recanalized vessels. Of the patients with unsuccessful recanalization, only 5 reported some symptomatic improvement during the observation period, 39 (57%) needed immediate amputation, and an additional 8 (4.7%) were amputated later on. Considering the fact that all patients were previously refused for bypass surgery owing to unsuitable runoff vessels or bad general condition, the long-term results were surprisingly good, suggesting that thrombolytic treatment, combined in remnant stenosis with PTA, was an efficient method in patients with acute or subacute arterial occlusions.