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Transcatheter therapy of severe acute lower extremity ischemia
1Department of Radiology, Veterans Administration Medical Center, Palo Alto, CA.
Insights
Transcatheter revascularization effectively treated severe acute lower extremity ischemia in patients unsuitable for surgery. This approach offers a viable alternative for limb salvage when reperfusion strategies ensure adequate blood flow.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Severe acute lower extremity ischemia presents a significant challenge, often with limited treatment options.
- Surgical revascularization may not be feasible or preferred in all patients with extensive vascular occlusions.
Purpose of the Study:
- To evaluate the efficacy of transcatheter revascularization in patients with severe acute lower extremity ischemia and extensive occlusions.
- To assess the outcomes of endovascular techniques when surgical options are exhausted or contraindicated.
Main Methods:
- Eleven patients with severe acute lower extremity ischemia underwent transcatheter revascularization.
- Procedures included accelerated thrombolysis with urokinase, angioplasty, vasodilators, and pedal arterial flow loops.
- Ischemia severity was categorized (2 or 3), and occlusion locations were documented.
Main Results:
- 100% initial success was achieved in Category 2 ischemia patients, with eight limbs saved.
- One Category 2 patient required amputation due to persistent occlusion.
- In Category 3 ischemia, one procedure failed, and the other reduced amputation level.
Conclusions:
- Transcatheter revascularization is a viable treatment for severe acute lower extremity ischemia.
- Successful outcomes depend on establishing both inflow and microcirculatory outflow through reperfusion strategies.
Purpose:
Transcatheter methods of revascularization were performed in 11 patients with severe acute lower extremity ischemia and extensive vascular occlusions in whom surgical revascularization was not possible (10 patients) or was not preferred (one patient).
Patients And Methods:
The acute ischemia was considered category 2 in nine patients and category 3 in two. Vascular occlusions were located in the superficial femoral artery in four patients, popliteal artery in 10, all three crural arteries in 10, and two crural arteries in one. Transcatheter methods included accelerated thrombolysis with 325,000 to 1.75 million U of urokinase, adjunct angioplasty, use of intraarterial vasodilators, and creation of pedal arterial flow loops.
Results:
Initial success was 100% in the nine patients with category 2 ischemia. Eight limbs were saved; one occlusion at 10 days necessitated below-knee amputation. For the two patients with category 3 ischemia, one procedure failed and the other reduced the level of amputation.
Conclusion:
In patients with severe acute ischemia, transcatheter revascularization is a viable treatment option when strategies for reperfusion establish both inflow and microcirculatory outflow.