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Thrombolytic therapy in acute lower limb ischemia
1Department of Internal Medicine, Karl-Franzens University, Graz, Austria.
Seminars in Thrombosis and Hemostasis
|January 1, 1996
Summary
Catheter-directed intra-arterial thrombolysis (IAT) offers a less invasive approach for acute lower limb ischemia (ALLI). Studies show IAT has comparable initial outcomes to surgery but better long-term survival rates with lower complication risks.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Thrombolytic Therapy
Background:
- Surgical revascularization for acute lower limb ischemia (ALLI) carries high mortality and amputation risks.
- Catheter-directed intra-arterial thrombolysis (IAT) presents a less invasive alternative for ALLI treatment.
Purpose of the Study:
- To compare the efficacy and safety of IAT versus surgical revascularization as initial therapy for ALLI.
- To evaluate long-term outcomes, including event-free survival, amputation, and mortality rates.
Main Methods:
- Two randomized studies comparing IAT with surgical revascularization for ALLI.
- Use of low-dose recombinant tissue-type plasminogen activator (rt-PA) in IAT.
Main Results:
- No significant difference in primary revascularization, amputation, or mortality rates between IAT and surgery.
- Significantly higher 6-month and 12-month event-free survival rates observed in the IAT groups compared to surgical groups.
- Low-dose rt-PA in IAT demonstrated rapid lysis with low bleeding complications, unlike high-dose urokinase.
Conclusions:
- IAT is a viable and potentially superior initial therapy for ALLI, especially for viable or threatened limbs without neurologic deficit.
- IAT can obviate the need for immediate surgery in about one-third of patients and allow elective correction in another third, reducing overall mortality and morbidity.