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Peripheral arterial thrombolysis: intermediate-term results
R J Lonsdale1, S C Whitaker, D C Berridge
1Department of Vascular Surgery, University Hospital, Nottingham, UK.
Insights
Intra-arterial thrombolysis shows good intermediate-term results when successful within 30 days. Successful treatment leads to sustained arterial patency and limb salvage in most patients.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Intra-arterial thrombolysis is a critical treatment for acute limb ischemia.
- Understanding the intermediate-term outcomes is essential for patient management and treatment planning.
Purpose of the Study:
- To evaluate the intermediate-term results of intra-arterial thrombolysis.
- To assess the patency rates and limb salvage following successful thrombolysis.
Main Methods:
- Retrospective review of 129 consecutive intra-arterial thrombolysis courses in 127 patients.
- Median follow-up duration of 3 years.
- Assessment of thrombolysis success at 30 days, patency, reocclusion, and limb outcomes.
Main Results:
- Successful thrombolysis was achieved in 49% of cases (63/129).
- Among successful cases, estimated arterial patency rates were 80% at 1 year, 72% at 2 years, and 70% at 3 years.
- Intermediate-term results were significantly worse for unsuccessful thrombolysis cases (24% limb salvage).
Conclusions:
- Successful intra-arterial thrombolysis yields good intermediate-term results with high patency and limb salvage rates.
- Treatment success at 30 days is a key predictor of favorable long-term outcomes.
Abstract:
To determine the intermediate-term results of intra-arterial thrombolysis, 127 consecutive patients receiving 129 courses of treatment were reviewed at a median follow-up of 3 years. At initial review, 30 days after treatment, thrombolysis was successful in 63 cases (49 per cent). Of these patients, 16 were lost to follow-up: 15 died without further vascular symptoms and one moved from the area. Some 35 patients were alive and asymptomatic, of whom 33 had either angiographic or clinical evidence of continued arterial patency. Symptomatic reocclusion occurred in 12 cases; a further two patients remained asymptomatic and reocclusion was detected at follow-up. Two of the 12 symptomatic patients required amputation. Estimated patency rates were 80 per cent at 1 year, 72 per cent at 2 years and 70 per cent at 3 years. The intermediate-term results in the 66 cases in which lysis was unsuccessful were worse, only 16 patients (24 per cent) surviving to follow-up with the treated limb intact. It is concluded that, if thrombolysis is successful at 30 days, the intermediate-term results are good.