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Catheter-directed thrombolysis for lower limb ischaemia: A retrospective study of treatment outcomes

Sophie Parker1, David John Midgley1, Ella Iosua2

  • 1Radiology Department, Dunedin Public Hospital, Dunedin, New Zealand.

Journal of Medical Imaging and Radiation Oncology
|December 8, 2022
PubMed

Insights

Catheter-directed thrombolysis (CDT) for lower limb ischaemia shows moderate 12-month patency rates (44%). Combining CDT with endovascular procedures improves technical success but requires careful patient selection due to complication risks.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Cardiovascular Medicine

Background:

  • Lower limb ischaemia is a critical condition requiring prompt intervention.
  • Catheter-directed thrombolysis (CDT) is an established treatment for arterial occlusion.
  • Assessing CDT outcomes and influencing factors is crucial for optimizing patient care.

Purpose of the Study:

  • To evaluate the immediate and long-term treatment outcomes of CDT.
  • To determine the patency rates of treated arteries up to 12 months post-procedure.
  • To investigate how occlusion age and treatment duration affect CDT success and complication rates.

Main Methods:

  • A 10-year retrospective observational study (2010-2019) at a single institution.
  • Analysis of patient demographics, vessel occlusion factors, and treatment data.
  • Kaplan-Meier analysis used for assessing patency data.

Main Results:

  • 218 limbs in 159 patients treated; 74.5% due to in situ thrombosis or occluded bypass grafts.
  • Technical success: 55.5% with CDT alone, 84.4% with adjunctive endovascular procedures.
  • 12-month patency rate: 44%; 30-day major amputation rate: 8.2%; 30-day mortality: 6.3% (3 intracranial haemorrhages).

Conclusions:

  • Adjunctive endovascular procedures significantly enhance technical success rates for CDT.
  • While technically successful, CDT demonstrates only moderate long-term patency (44% at 12 months).
  • Bleeding complications and the balance of technical versus long-term success are critical factors in patient selection for CDT.
Abstract

Keywords:
angiographyinterventionvascular imagingvascular interventional radiology

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