Local intra-arterial thrombolysis in limb-threatening ischaemia

The purpose of this study was to determine the angiographic and clinical success rate and the immediate limb salvage and mortality rate after intra-arterial thrombolysis in limb-threatening ischaemia. A retrospective study of 66 patients treated with intra-arterial thrombolysis for 71 episodes of limb-threatening ischaemia was carried out. Immediate angiographic recanalisation rate, pre- and post-treatment ankle-brachial index (ABI) and clinical stage were established. Major amputations and deaths were recorded. The immediate primary angiographic recanalisation was complete in 25 cases and partial in 20 cases. Combined complete plus partial recanalisation rate was thus 63.4% (45/71). The overall mean ABI after treatment was significantly higher than before treatment (0.35 versus 0.68), excluding patients undergoing amputation. Clinical improvement was achieved in 59.2% of cases for one month after treatment. The amputation rate was 18.3% during the first month and 29.6% during the median follow-up of 16 weeks. The mortality rates were 6.1% and 33.3% respectively. Despite a high mortality the complications of thrombolysis were few emphasizing the relative safety of this method in treating limb threatening ischaemia. Furthermore, thrombolysis may identify the underlying pathology, which can be corrected by additional surgery or interventional procedure.