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[Intra-arterial thrombolysis using rt-PA for the treatment of occluded infra-inguinal bypasses]
P E Magnan1, G Moulin, C Chagnaud
1Service de Chirurgie Vasculaire, Hôpital Sainte-Marguerite, Marseille.
Insights
Percutaneous intra-arterial thrombolysis effectively treated obstructed infra-inguinal bypass grafts. Recombinant tissue-type plasminogen activator (rt-PA) demonstrated success in restoring blood flow for critical limb ischemia.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Thrombolytic Therapy
Context:
- Obstructed infra-inguinal bypass grafts pose a significant challenge in vascular surgery.
- Critical limb ischemia necessitates timely and effective interventions to prevent amputation.
- Percutaneous intra-arterial thrombolysis offers a minimally invasive approach to restore graft patency.
Purpose:
- To evaluate the efficacy and safety of percutaneous intra-arterial thrombolysis using recombinant tissue-type plasminogen activator (rt-PA) for obstructed infra-inguinal bypass grafts.
- To assess the outcomes in patients presenting with varying degrees of limb ischemia.
Summary:
- A study involving 32 patients (41 procedures) treated obstructed infra-inguinal bypass grafts between 1990 and 1993.
- The procedure utilized recombinant tissue-type plasminogen activator (rt-PA) with a bolus injection followed by continuous infusion, alongside intravenous heparin.
- Patients presented with intermittent claudication, rest pain, or severe ischemia, with bypass grafts constructed from various materials and anastomosed at different arterial levels.
Impact:
- Percutaneous intra-arterial thrombolysis with rt-PA is a viable treatment option for acute infra-inguinal bypass graft occlusion.
- The study highlights the potential for successful reperfusion and limb salvage in patients with critical limb ischemia.
- Findings contribute to the understanding of endovascular techniques for managing bypass graft complications.
Abstract:
From July 1990 to July 1993, we performed 41 percutaneous intra-arterial thrombolysis procedures for the treatment of obstructed infra-inguinal bypass grafts in 32 patients. There were 27 men and five women with a mean age of 63 +/- 17 years (range 21 to 83 years). The symptoms of occlusion were intermittent claudication in three cases, rest pain in 12 cases, severe ischemia without sensitive-motor loss in 26 cases. Bypasses were achieved using a prosthesis in 18 cases (43.9%), a saphenous vein in 10 cases (24.4%), an arterial allograft in nine cases (21.9%), and a composite prosthesis-vein graft in four cases (9.8%) (table I). The distal anastomosis of the bypass graft was located on the popliteal artery in 26 cases (63.4%) and a crural artery in 15 cases (36.6%). The mean duration of the occlusion was 4.9 +/- 3.4 days (range 1 to 15 days). The percutaneous approach was through the contralateral common femoral artery in 26 cases (63.4%), through the ipsilateral common femoral artery in seven cases (17.1%), through the left humeral artery in eight cases (19.5%). In all cases the thrombolytic agent was the recombinant tissue-type plasminogen activator (rt-PA). Each procedure began with the injection of a five milligram bolus of rt-PA into or onto the thrombus followed by infusion of rt-PA into the thrombus at a dose of 0.05 mg/kg/h. Intravenous heparin was simultaneously administered. Serum fibrinogen, prothrombin time, and partial thromboplastin time (PTT) were measured every three hours.(ABSTRACT TRUNCATED AT 250 WORDS)