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Catheter-Directed Thrombolysis in the Management of Thrombotic Peripheral Artery Occlusions-Acute and Mid-Term

Ulrich Beschorner1, Tanja Boehme1, Elias Noory1

  • 1University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Südring 15, 79189 Bad Krozingen, Germany.

Journal of Clinical Medicine
|October 16, 2024
PubMed

Insights

Catheter-directed thrombolysis (CDT) effectively treats peripheral artery disease but carries a high risk of serious adverse events, particularly bleeding complications. Advanced age, alprostadil use, and longer lysis duration increase these risks.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Cardiovascular Medicine

Background:

  • Symptomatic peripheral artery disease (PAD) poses significant clinical challenges.
  • Catheter-directed thrombolysis (CDT) is an endovascular option for PAD.
  • Real-world data on CDT safety and efficacy in PAD is crucial.

Purpose of the Study:

  • To evaluate the safety and efficacy of CDT using recombinant tissue plasminogen activator (rt-PA) in real-world PAD practice.
  • To identify predictors of serious adverse events (SAEs) and specific complications like bleeding and reperfusion edema/compartment syndrome.
  • To assess limb salvage and target lesion revascularization (TLR) rates following CDT.

Main Methods:

  • Retrospective analysis of 1238 consecutive patients treated with CDT between 2013 and 2020.
  • Primary endpoint: rate of SAEs until discharge.
  • Secondary endpoints: interventional success, bleeding, reperfusion edema/compartment syndrome, limb salvage, and TLR.

Main Results:

  • CDT was successful in 95.1% of patients.
  • SAEs occurred in 41.3% (314 bleeding complications, 95 reperfusion edema/compartment syndrome).
  • Amputation occurred in 42 patients; 33 patients died. Age, abciximab/alprostadil use, and lysis duration predicted SAEs and bleeding.

Conclusions:

  • CDT is an effective endovascular treatment for thrombotic PAD.
  • The procedure is associated with a high complication rate.
  • Increasing age, alprostadil use, and lysis duration are independent risk factors for SAEs and bleeding.

Keywords:
amputationbleedingcatheter-directed thrombolysiscomplicationperipheral artery diseaseserious adverse events

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