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Updated: Oct 13, 2025

Minimally Invasive Isolated Limb Perfusion (MI-ILP) for Locally Advanced Melanomas and Sarcomas of the Extremity
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Infusion techniques for peripheral arterial thrombolysis.

Cathryn Broderick1, Jai V Patel2

  • 1Usher Institute, University of Edinburgh, Edinburgh, UK.

The Cochrane Database of Systematic Reviews
|November 17, 2021
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Summary

This review found insufficient evidence to determine if different thrombolysis infusion techniques improve outcomes for acute limb ischaemia. Intra-arterial infusion may improve vessel patency, but risks of minor bleeding exist with high-dose and IV regimens.

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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Pharmacology

Background:

  • Acute limb ischaemia (ALI) is a critical condition caused by arterial blockage, potentially leading to irreversible damage and amputation if not treated promptly.
  • Thrombolysis, using fibrinolytic drugs to dissolve blood clots, is a less invasive treatment option for ALI compared to surgery.
  • This review is an update of a 2004 analysis, focusing on comparing different infusion techniques for fibrinolytic agents in ALI management.

Purpose of the Study:

  • To compare the effectiveness of various infusion techniques used during peripheral arterial thrombolysis for treating patients with acute limb ischaemia.
  • To evaluate outcomes such as limb salvage, amputation rates, mortality, vessel patency, and complications associated with different thrombolytic delivery methods.

Main Methods:

  • Systematic search of multiple databases (Cochrane Vascular, CENTRAL, MEDLINE, Embase, CINAHL) and clinical trial registries up to October 2020.
  • Inclusion of all randomized controlled trials (RCTs) comparing fibrinolytic infusion techniques for ALI.
  • Assessment of risk of bias using the Cochrane 'Risk of bias' tool and certainty of evidence using GRADE. Due to heterogeneity, results were reported narratively, not via meta-analysis.

Main Results:

  • Nine RCTs with 671 participants were included, assessing various techniques like intravenous (IV) vs. intra-arterial (IA) delivery, high-dose vs. low-dose, and continuous vs. forced infusion.
  • Evidence certainty was very low to low due to study limitations, heterogeneity in populations, and outcome measures.
  • Intra-arterial (IA) infusion showed higher likelihood of complete vessel patency (OR 13.22) compared to intravenous (IV) infusion, though with increased minor bleeding risk.
  • High-dose and forced-infusion techniques reduced thrombolysis duration but were associated with more minor bleeding complications.

Conclusions:

  • Insufficient evidence exists to support one thrombolytic regimen over another for improving amputation-free survival, amputation rates, or mortality in ALI.
  • While IA infusion may enhance vessel patency, high-dose and IV regimens might increase risks of cerebrovascular accident (CVA) and major bleeding.
  • Thrombolysis can be considered for marginally threatened limbs, but caution is advised for non-limb-threatening ischaemia due to potential risks.