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Intraoperative catheter thrombolysis as an adjunct to surgical revascularisation for infrainguinal limb-threatening
1Department of Thoracic and Cardiovascular Surgery, University of Berne, Switzerland.
Insights
Intraoperative thrombolysis (IOL) offers significant benefits for acute leg ischemia. This procedure, followed by surgical restoration, shows promising results in limb salvage and vessel patency with minimal complications.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Thrombotic Disease Management
Background:
- Acute leg ischemia poses a significant risk to limb viability.
- Atherosclerotic lesions, graft occlusions, and arterial injuries are common causes.
- Effective treatment strategies are crucial for limb salvage and patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of intraoperative thrombolysis (IOL) in patients with acute, limb-threatening leg ischemia.
- To assess the impact of IOL on postoperative morbidity, mortality, patency rates, and limb salvage.
- To determine the overall benefits of IOL as an adjunct to surgical revascularization.
Main Methods:
- A prospective study involving 25 patients with infrainguinal limb-threatening ischemia.
- Intraoperative thrombolysis using urokinase was administered via targeted arterial access.
- Procedures included graft thrombectomy, femoropopliteal bypass, angioplasty, and vein patch angioplasty.
- Outcomes were monitored for up to 2 years, focusing on patency and limb salvage.
Main Results:
- Postoperative bleeding complications were minimal (8%), with two cases of wound hematoma.
- Four patients died within 30 days, but no deaths were directly attributed to IOL.
- Patency rates were 71% at 6 months, and limb salvage rates were 86% at 2 months.
- Mean follow-up duration was 10.9 months.
Conclusions:
- Intraoperative thrombolysis (IOL) followed by surgical inflow restoration is a feasible and effective treatment for limb-threatening ischemia.
- The procedure demonstrates favorable outcomes regarding safety, vessel patency, and limb salvage.
- IOL represents a valuable addition to the surgical armamentarium for managing complex leg ischemia.
Abstract:
The objective of this study was to assess the benefits of intraoperative thrombolysis (IOL) on patients with acute leg ischaemia. This study was conducted in the Department of Cardiovascular Surgery, Inselspital, Berne, Switzerland. IOL was prospectively assessed in 25 patients with infrainguinal limb-threatening ischaemia due to acute thrombosis of atherosclerotic lesions and aneurysms (44%), occluded grafts (32%), arterial injuries (12%), delayed embolism (8%) and trash foot (8%). Three hundred and seventy-five thousand units of urokinase were delivered over 30 min with inflow occlusion to the profunda femoral artery in 8%, to the calf arteries via exposed trifurcation in 88% and to the pedal arch via exposed posterior tibial artery at the ankle in 8% of the patients. This was followed by graft thrombectomy in 24%, femoropopliteal bypass in 60%, intraoperative percutaneous transluminal angioplasty in 12% and vein patch angioplasty in 16%. Chief outcome measures were: postoperative morbidity; mortality; patency and limb salvage up to a maximum of 2 years. Postoperative bleeding complications occurred in two patients (8%) and consisted of two wound haematomas. Four patients died within 30 days after IOL, but no death could be attributed to IOL. All remaining patients were followed with a mean follow-up time of 10.9 months. The patency and limb salvage rate remained stable at 71 and 86% after 6 and 2 months, respectively. Conclusions were that IOL followed by surgical inflow restoration is a straightforward procedure for limb-threatening ischaemia with rewarding results regarding side effects, patency and limb salvage.