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Catheter-Directed Thrombolysis in the Treatment of Acute Ischemia in Lower Extremities Is Safe and Effective,
Lærke Urbak1, Louise de la Motte1, Peter Rørdam1
1Department of Vascular Surgery, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
Insights
Catheter-directed thrombolysis (CDT) is safe for acute lower extremity ischemia, especially with endovascular treatment. However, lack of distal run-off significantly increases amputation and mortality risks.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Acute lower extremity ischemia requires timely intervention.
- Catheter-directed thrombolysis (CDT) is a treatment option for limb salvage.
Purpose of the Study:
- To assess pre-procedural factors influencing outcomes and safety of CDT.
- To identify predictors of success and complications in CDT for acute lower extremity ischemia.
Main Methods:
- Retrospective analysis of 249 patients undergoing CDT from 2006-2012.
- Evaluation of primary patency, hemorrhagic complications, amputation, and mortality rates.
Main Results:
- Overall primary patency was 76%, highest with CDT plus endovascular treatment (87%).
- No distal run-off on angiography correlated with increased 30-day amputation (OR 2.31) and mortality (OR 5.84).
- Delayed treatment (8-14 days) also increased amputation risk (OR 4.09).
Conclusions:
- CDT is a feasible and safe treatment for acute lower extremity ischemia, particularly when combined with angioplasty and stenting.
- Absence of distal run-off is a critical predictor of poor outcomes, including higher amputation and mortality rates.
Abstract:
Objective: To evaluate the influence of pre-procedural characteristics on immediate and late results as well as the safety of catheter-directed thrombolysis (CDT) in acute ischemia of the lower extremity. Materials and Methods: A retrospective study comprising 249 patients treated by CDT from January 2006 to December 2012. Outcomes were primary patency, haemorrhagic complications, amputation and mortality. Results: Primary patency for CDT alone was 68%, for CDT plus endovascular treatment 87% and for successful CDT with supplementary surgery 62% giving an overall primary patency of 76%. Two (0.8%) patients suffered from cerebral haemorrhage during CDT. We found a significant correlation between 30 day amputation rate and no visual distal run-off at CDT start (OR 2.31; CI95% 1.09-4.91; p-value=0.02) and onset of symptoms to CDT start of 8-14 days (OR 4.09; CI95% 1.42-11.81; p-value=0.01). Lack of visualized distal run-off was also associated with a significant risk of 30 day mortality (OR 5.84; CI95% 1.26-27.00; p-value=0.02). Conclusion: Our results show that CDT is a feasible and safe treatment option especially when combined with angioplasty +/- stent. However, no distal run-off at primary angiography is associated with higher rates of amputation during follow-up and 30 day mortality.