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[Thrombolytic therapy in acute lower extremity ischemia]
P Rørdam1, M T Enevoldsen, J B Grønvall Rasmussen
1Karkirurgisk afdeling RK, Rigshospitalet, København.
Ugeskrift for Laeger
|September 2, 1996
Summary
Thrombolytic therapy for acute lower extremity ischemia offers a 69% limb salvage rate initially, though long-term amputation rates increase. Angiographic evidence of success isn't always apparent but doesn't negate treatment effectiveness.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Acute lower extremity ischemia is a critical condition requiring prompt intervention.
- Reconstructive vascular surgery is not always feasible due to patient comorbidities or arterial anatomy.
Purpose of the Study:
- To evaluate the effectiveness of thrombolysis in treating acute lower extremity ischemia.
- To assess limb salvage rates and long-term outcomes in patients treated with thrombolysis.
Main Methods:
- Retrospective analysis of 37 lower extremities treated with thrombolysis over 4.5 years.
- Assessment of angiographic findings, surgical intervention feasibility, and patient outcomes including limb salvage and amputation rates.
- Follow-up evaluation of ankle-brachial pressure index (ABPI) in salvaged limbs.
Main Results:
- Initial limb salvage rate was 69%, with 2 deaths within one month.
- Long-term follow-up showed an additional six amputations, resulting in a final limb salvage rate of 49%.
- Demonstrable angiographic effect of thrombolysis was observed in only 35% of cases, but salvaged limbs had a mean ABPI of 0.63.
Conclusions:
- Thrombolytic therapy is a viable option for acute lower extremity ischemia when reconstructive procedures are not suitable.
- The absence of clear angiographic evidence of thrombolysis does not necessarily indicate treatment failure.
- Careful patient selection and outcome monitoring are crucial in managing acute limb ischemia with thrombolysis.