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Early results and 1-year follow-up after intra-arterial thrombolysis
D J Browse1, E P Torrie, R B Galland
1Department of Surgery, Royal Berkshire Hospital, UK.
Insights
Intra-arterial thrombolysis (IAT) effectively treated arterial occlusions, with earlier treatment yielding better results. While complications occurred, IAT proved valuable for acute cases and specific graft interventions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Arterial occlusions present significant challenges in acute, subacute, and chronic ischemia.
- Intra-arterial thrombolysis (IAT) is an established treatment modality.
Purpose of the Study:
- To evaluate the efficacy and safety of IAT as a primary treatment for arterial occlusions.
- To assess factors influencing IAT success, including timing and occlusion type.
Main Methods:
- A retrospective analysis of 100 patients treated with IAT for arterial occlusions.
- Use of streptokinase or tissue plasminogen activator for thrombolysis.
- Radiological assessment of lysis, complication rates, and 1-year patency.
Main Results:
- Complete lysis was achieved in 55% of cases, with partial lysis in 20%.
- Earlier treatment (within 1 week) significantly improved 1-year patency rates (71% vs. 36%).
- Major complications occurred in 7% of patients, including hemorrhage and cerebrovascular accidents.
Conclusions:
- IAT is more effective for acute than chronic occlusions.
- IAT is a viable option for selected cases, particularly acute occlusions and thrombosed aortofemoral grafts or popliteal aneurysms.
- Timely intervention is crucial for optimal outcomes with IAT.
Abstract:
Intra-arterial thrombolysis (IAT) was used as first-line treatment for 100 occlusions causing acute, subacute or chronic ischaemia. Streptokinase was used in 90 cases and tissue plasminogen activator in the remaining ten. Complete lysis, as determined radiologically, was achieved in 55 per cent of cases and partial lysis in 20 per cent. Lysis was more effective the earlier it was used. Major complications occurred in seven cases: five patients suffered major haemorrhage, two of whom died, and two had haemorrhagic cerebrovascular accidents. Of the patients with complete or partial clearance of thrombosis, 19 had no underlying apparent cause, 23 underwent angioplasty and 15 had an operation. The 1-year patency rate following complete lysis was 58 per cent. The 1-year patency rate after successful treatment commencing within 1 week of symptoms starting was 71 per cent, compared with 36 per cent for later treatment. Aortofemoral bifurcation grafts were cleared in three of five cases and all remain patent. Eight popliteal aneurysms were demonstrated by IAT and were ligated and bypassed; all these grafts remained patent at follow-up. IAT is less effective in chronic than acute occlusion. It should be reserved for patients in whom the occlusion is of short duration or for those with a thrombosed aortofemoral bifurcation graft or popliteal aneurysm.