Related Experiment Videos
Clinical and angiographic selection factors for thrombolysis as initial therapy for acute lower limb ischemia
T O McNamara1, K R Gardner, R A Bomberger
1Angio/Interventional Section, UCLA School of Medicine, UCLA Medical Center 90095-1721, USA.
Insights
Angiographic patterns in acute lower limb ischemia (ALLI) correlate with clinical severity and predict outcomes of percutaneous intraarterial thrombolysis (PIAT). This imaging approach offers a valuable tool for guiding ALLI treatment decisions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Diagnostic Imaging
Background:
- Acute lower limb ischemia (ALLI) presents a significant clinical challenge.
- Percutaneous intraarterial thrombolysis (PIAT) is a treatment option for ALLI.
- Predicting treatment success in ALLI is crucial for patient outcomes.
Purpose of the Study:
- To investigate the correlation between angiographic patterns and clinical severity of ALLI.
- To determine if angiographic patterns predict the outcome of PIAT for ALLI.
- To compare PIAT outcomes with emergency surgical treatment for ALLI.
Main Methods:
- Retrospective analysis of 186 PIAT infusions in 160 ALLI patients.
- Evaluation of angiograms for occlusion segments, stenoses, and distal vessel patency.
- Correlation of angiographic findings with clinical severity and 30-day PIAT outcomes (patency, amputation, mortality).
Main Results:
- Three distinct angiographic categories (I, II, III) correlated with "viable," "threatened," and "irreversible" ALLI classifications, respectively.
- Category I showed 100% patency, 0% amputation, 0% mortality.
- Category III showed 55% patency, 19% amputation, 5% mortality, demonstrating a clear outcome gradient.
- Category II outcomes were intermediate (90% patency, 8.6% amputation, 0.7% mortality).
Conclusions:
- Angiographic patterns effectively correlate with ALLI clinical severity.
- Angiographic patterns serve as reliable predictors of PIAT outcomes.
- PIAT, guided by angiographic assessment, may offer lower amputation and mortality rates compared to emergency surgery for ALLI.
Abstract:
The purpose of this study was to determine whether angiographic patterns correlate with the clinical severity of acute lower limb ischemia (ALLI) and with the outcome of treatment with percutaneous intraarterial thrombolysis (PIAT). A retrospective analysis was conducted of angiograms and case records of 186 consecutive PIAT infusions in 160 patients with ALLI. The number of segments of occlusions; associated stenoses of inflow, outflow, and collateral vessels; and the demonstration of patent distal vessels were correlated with severity of ischemia and outcome of PIAT. Occlusions requiring flow to traverse one collateral bed to supply patent distal vessels (angiographic category I) correlated with the "viable" clinical classification of ALLI. Those requiring blood to flow through two contiguous collateral beds to supply patent distal vessels (category II) correlated with the "threatened" clinical classification. Occlusions with distal propagation that occluded the distal vascular bed (category III) correlated with the "irreversible" clinical category. Rates at 30 days for patency, amputation, and mortality were as follows for category I: 100%, 0%, and 0%; category II: 90%, 8.6%, and 0.7%; and category III: 55%, 19%, and 5%, respectively. Angiographic patterns correlate well with clinical severity of ischemia and predict the outcome from PIAT as initial therapy of ALLI. Amputation and mortality rates are less than those reported for emergency surgical treatment of ALLI.