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Computerized angiographic analysis of the outcome of peripheral thrombolysis
B D Braithwaite1, P V Petrik, A W Ritchie
1Department of Vascular Surgery, University of California, Los Angeles, USA.
Insights
Catheter-directed thrombolysis for acute limb ischemia shows improved limb salvage when underlying stenosis is treated and more run-off vessels are present. A computerized angiographic analysis system aids in predicting treatment success.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Catheter-directed peripheral thrombolysis is increasingly utilized for acute limb ischemia.
- Challenges exist in comparing thrombolysis techniques due to patient and procedural variability.
Purpose of the Study:
- To develop and utilize a computerized angiographic analysis system for evaluating thrombolysis outcomes.
- To identify factors influencing limb salvage rates in patients undergoing thrombolysis.
Main Methods:
- A computerized database storing angiographic information was created.
- 201 patients with rest pain undergoing thrombolysis were analyzed using this database.
Main Results:
- Limb salvage rates were significantly higher when underlying stenosis was treated (82% vs. 58%) and with at least one run-off vessel (30% increase).
- Occlusion of fewer than 5 arterial segments correlated with better limb salvage (85% vs. 57%).
- Graft occlusion outcomes showed a trend towards better salvage with fewer occluded segments (90% vs. 72%).
Conclusions:
- A user-friendly computerized angiographic analysis system facilitates detailed examination of thrombolytic practices.
- This system can assist in predicting the success of thrombolysis for acute limb ischemia.
Background:
Catheter-directed peripheral thrombolysis is used increasingly for the management of acute limb ischemia. The comparison of different agents and techniques has proven difficult because of the variations in patient presentation, vessel involvement, and treatment methods.
Methods:
A computerized database in which angiographic information is stored on computerized arterial maps has been designed to record details of thrombolysis.
Results:
A total of 201 patients who presented with rest pain were recorded on the database, and their angiograms were analyzed. There were 123 native-vessel and 78 graft occlusions. Immediate success of lysis and 30-day outcome were not dependent on the site of the occlusion. If an underlying stenosis was revealed, limb salvage rates were significantly greater than when none was found (82% versus 58%, P < 0.01). The presence of at least 1 run-off vessel increased limb salvage rates by 30% (P < 0.001). If more than 5 arterial segments were occluded on the prelysis angiogram, limb salvage was worse than if there were fewer than 5 (57% versus 85%, P < 0.0001). For grafts, less than 5 segments of occlusion led to limb salvage rates of 90%, and more than 5 segments of occlusion led to rates of 72% (P = 0.07).
Conclusions:
This simple and user-friendly system of computerized angiographic analysis will enable detailed examination of thrombolytic practice and assist in the prediction of success.