Catheter Directed Thrombolysis Protocols for Peripheral Arterial Occlusions: a Systematic Review

Area of Science:

• Vascular Surgery
• Interventional Radiology

Background:

• Catheter directed thrombolysis (CDT) is a key treatment for acute limb ischemia due to peripheral arterial occlusions.
• Existing CDT protocols exhibit significant heterogeneity, necessitating optimization to enhance outcomes and minimize bleeding risks.

Purpose of the Study:

• To systematically review and analyze the efficacy and safety of various CDT protocols for peripheral arterial occlusions.
• To identify optimal CDT strategies for improving patient outcomes and reducing complications.

Main Methods:

• A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases.
• Study selection, quality assessment, and data extraction were performed by two independent reviewers.
• Primary outcomes included treatment duration, success rates, and bleeding complications; secondary outcomes were mortality and amputation rates.

Main Results:

• Analysis of 106 studies (10,643 cases) revealed a mean treatment duration of 21.4 hours and an angiographic patency rate of 75%.
• Lower fibrinolytic dose protocols showed comparable success rates to high-dose protocols but with significantly reduced bleeding complications (13.4% vs. 16.7%).
• Bleeding complications occurred in 18% of patients, highlighting it as a primary concern in CDT.

Conclusions:

• CDT is an effective treatment for peripheral arterial occlusions, with bleeding complications being a major risk.
• Pooled data suggest that lower fibrinolytic doses may offer a favorable balance between efficacy and safety, despite longer treatment times.
• Significant heterogeneity in protocols and lack of reporting standards in the literature impede definitive meta-analysis and further optimization.