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Thrombolysis and angioplasty of chronic iliac artery occlusions
A Motarjeme1, G I Gordon, K Bodenhagen
1Midwest Vascular Institute, Downers Grove, IL 60515, USA.
Insights
Percutaneous angioplasty combined with thrombolysis is effective for chronic iliac artery occlusions. This treatment achieved an 86% success rate, with over 80% of patients symptom-free at 5 years.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- The efficacy of percutaneous angioplasty for chronic iliac artery occlusions remains debated.
- A significant patient cohort experiences chronic limb ischemia due to these occlusive diseases.
Purpose of the Study:
- To evaluate the long-term effectiveness and safety of combined thrombolysis and angioplasty in managing chronic iliac artery occlusions.
- To assess patient outcomes, including symptom resolution and complication rates.
Main Methods:
- A retrospective review of 99 patients with complete chronic iliac artery occlusions treated with urokinase thrombolysis followed by angioplasty.
- Urokinase infusion at 60,000-80,000 IU/h for 24 hours, with angioplasty performed subsequently.
- Patient selection criteria were broad, including age, lesion length, and disease severity.
Main Results:
- Seventy-nine percent of patients responded to thrombolysis, with 55% achieving complete lysis.
- Angioplasty success rates were 100% with complete lysis and 88% with partial lysis.
- The overall procedure success rate was 86%, with over 80% of survivors symptom-free at 5 years. The 30-day mortality was 2%.
Conclusions:
- Combined thrombolysis and angioplasty represent an effective treatment strategy for chronic iliac artery occlusions.
- The procedure demonstrates a favorable long-term outcome profile with acceptable complication and mortality rates.
- This approach offers a viable option for patients with extensive peripheral vascular disease affecting the iliac arteries.
Abstract:
The role of percutaneous angioplasty in the management of chronic iliac artery occlusions is controversial. This article reviews 7 years of experience in treating patients with complete chronic iliac artery occlusions (n = 99) by using thrombolysis and angioplasty. Patients were not excluded due to age or length of the lesion, or severity of underlying peripheral vascular disease. Thrombolysis was conducted with infusion of urokinase at a rate of 60,000-80,000 IU/h for 24 hours. Angioplasty was then performed irrespective of the results of thrombolysis. Seventy-nine percent of patients responded to urokinase, with complete lysis achieved in 55%. Angioplasty was successful in all patients with complete thrombolysis and in 88% of those with partial thrombolysis. The overall success rate was 86%, and more than 80% of surviving patients were symptom free at 5 years. There were seven complications, and the 30-day mortality rate was 2%. Our present results confirm the efficacy of thrombolysis/angioplasty for chronic arterial occlusions.