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Acute limb deterioration during intra-arterial thrombolysis
R B Galland1, J J Earnshaw, R N Baird
1Department of Surgery, Royal Berkshire Hospital, Reading, UK.
The British Journal of Surgery
|September 1, 1993
Summary
Acute limb deterioration during intra-arterial thrombolysis (IAT) affects 2.3% of treatments, particularly those for thrombosed popliteal aneurysms. Operative intervention is superior to continued lysis for managing this complication.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Thrombolytic Therapy
Background:
- Intra-arterial thrombolysis (IAT) is a common treatment for limb ischemia.
- Distal embolism or thrombus extension occurs in approximately 12% of IAT procedures.
- While often manageable, acute limb deterioration can rapidly worsen patient outcomes.
Purpose of the Study:
- To determine the incidence of acute limb deterioration during IAT.
- To identify risk factors associated with this complication.
- To compare treatment outcomes for acute limb deterioration.
Main Methods:
- Retrospective data collection from five UK centers experienced in IAT.
- Analysis of 866 IAT treatments.
- Comparison of complication rates across different underlying causes of limb ischemia.
Main Results:
- 20 out of 866 limbs (2.3%) experienced acute deterioration during IAT.
- This complication was significantly more frequent in cases of thrombosed popliteal aneurysm compared to emboli or thrombosed arteries/grafts (P < 0.001).
- The amputation rate was high, and operative intervention yielded better results than continuing lysis.
Conclusions:
- Acute limb deterioration is a significant complication of IAT, occurring in 2.3% of cases.
- Thrombosed popliteal aneurysms represent a higher risk group for this complication.
- Prompt operative intervention is recommended over continued thrombolysis for managing acute limb deterioration during IAT.