Thrombolysis in acute lower limb ischaemia

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Pharmacology

Background:

• Balloon embolectomy is the standard for acute lower limb occlusion but shows limited success in thrombotic atherosclerotic vessels.
• Thrombolysis, using drugs like streptokinase, urokinase, and tissue plasminogen activator, has been explored for clot dissolution.
• Limitations exist in current thrombolytic therapies regarding efficacy and patient selection.

Purpose of the Study:

• To review the evolution and current status of thrombolysis in managing acute lower limb ischemia.
• To discuss advancements in thrombolytic drugs and administration methods.
• To explore the potential role of thrombolysis as an adjunct to surgical interventions.

Main Methods:

• Review of historical and current thrombolytic agents (streptokinase, urokinase, t-PA, anistreplase).
• Discussion of administration techniques, including intravenous, intra-arterial, and pharmaco-mechanical methods (e.g., pulsed spray catheters).
• Exploration of emerging thrombolytic drugs (e.g., single-chain urokinase-type plasminogen activator) and their potential.

Main Results:

• Intra-arterial administration is preferred over intravenous for thrombolysis.
• Pharmaco-mechanical methods may enhance lysis time and applicability, particularly in neurological emergencies.
• Newer agents show theoretical advantages, and thrombolysis as an adjunct to surgery is promising but requires more data.

Conclusions:

• Thrombolysis is increasingly important in peripheral limb ischemia management.
• Further research is needed to establish optimal patient selection, drugs, and administration protocols.
• A multidisciplinary team approach involving surgeons, radiologists, and hematologists is crucial for effective thrombolysis.