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Limitations of intra-arterial thrombolysis
M J Rickard1, C M Fisher, C V Soong
1Department of Vascular Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Cardiovascular Surgery (London, England)
|January 10, 1998
Summary
Urokinase thrombolysis for acutely ischemic limbs shows a 73% initial success rate but carries significant complication risks. Native arteries and vein grafts had better long-term patency than prosthetic grafts.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Thrombolytic Therapy
Background:
- Acute limb ischemia (ALI) poses a significant threat to limb viability.
- Thrombolysis is a key treatment modality for ALI, aiming to restore blood flow.
- Assessing the outcomes of thrombolysis is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the efficacy, costs, and complications of urokinase-induced thrombolysis for ALI.
- To compare the long-term patency rates of native arteries, vein grafts, and prosthetic grafts after thrombolysis.
Main Methods:
- Retrospective review of 45 episodes of urokinase thrombolysis in 37 patients with ALI.
- Analysis of initial success rates, need for adjunctive procedures (angioplasty, surgery), and complications.
- Comparison of patency rates based on the type of occluded vessel (native artery, vein graft, prosthetic graft).
Main Results:
- Initial thrombolysis success in 73% of episodes.
- Complications occurred in 42% of treatments, including bleeding (38%) and distal embolization (24%).
- Six-month patency was 44%; native arteries/vein grafts showed superior long-term patency compared to prosthetic grafts (P=0.008).
Conclusions:
- Urokinase thrombolysis is effective for ALI but associated with considerable complications.
- Native arteries and vein grafts demonstrate better long-term patency outcomes than prosthetic grafts.
- Cost-effectiveness analysis indicated an average cost of AUD$2440 for radiological procedures and disposables.