Intra-arterial thrombolysis for acute limb ischemia: a three-year experience

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Peripheral arterial thromboembolism and graft thrombosis pose significant threats to limb viability.
• Acute arterial insufficiency can lead to severe pain and incapacitation.

Purpose of the Study:

• To evaluate the efficacy and safety of percutaneous intra-arterial thrombolysis (IAT) for acute arterial insufficiency.
• To identify patient selection criteria for successful IAT outcomes.

Main Methods:

• Retrospective analysis of 32 extremities in 28 patients treated with IAT over three years.
• Assessment of limb salvage rates, thrombolysis success, and complication incidence.
• Comparison of outcomes in native arterial embolism versus arterial graft thrombosis.

Main Results:

• Overall success rate of 38% with thrombolysis occurring in 88% of cases.
• Limb salvage achieved in 84% of treated extremities.
• Higher success rates observed in native arterial embolism (67%) compared to arterial graft thrombosis (29%).
• Major complications occurred in 25% of cases, with a 6% IAT-related mortality rate.

Conclusions:

• IAT is a viable limb salvage option for acute limb ischemia, particularly for arterial emboli.
• Careful patient selection is crucial, favoring those with emboli, manageable ischemia duration, and good distal runoff.
• IAT may reduce the need for more extensive surgical interventions in select patients.