Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Acute arterial lower limb ischemia is a critical condition requiring timely intervention.
• Thrombolysis is a treatment option, but its long-term efficacy and outcomes based on etiology require further study.

Purpose of the Study:

• To assess the long-term clinical outcomes of intra-arterial thrombolysis for acute arterial lower limb ischemia.
• To compare these outcomes based on the underlying causes of arterial occlusion.

Main Methods:

• Retrospective analysis of a prospective database from two vascular centers (2001-2013).
• Inclusion of 689 procedures, with etiologies including graft/stent occlusion, thrombosis, embolus, and popliteal aneurysm.
• Survival data obtained via linkage with the Population Registry.

Main Results:

• Mean follow-up was 59.4 months; 32.9% required re-intervention, 16.4% amputation.
• Re-intervention rates were highest for graft/stent occlusions (48.0%) and lowest for emboli (16.3%).
• 5-year primary patency was 55.9%, higher for emboli (83.3%) and lower for graft occlusions (43.3%). Amputation-free survival at 5 years was 45.2%.

Conclusions:

• Intra-arterial thrombolytic therapy demonstrates favorable medium and long-term clinical outcomes.
• It effectively reduces the necessity for open surgical procedures in managing acute arterial lower limb ischemia.
• Etiology significantly influences outcomes, with embolic occlusions generally having better results than graft occlusions.