Potential Benefits From Heating the High-Dose rtPA Boluses Used in Catheter-Directed Thrombolysis for Acute/Subacute Lower Limb Ischemia

Abstract To investigate the correlation between plasma D-dimer levels before and after catheter-directed thrombolysis (CDT) in acute lower limb ischemia (ALI) and lower limb arterial recanalization and the clinical value of the change trend of plasma D-dimer. A retrospective review of all patients who received CDT for the treatment of ALI between January 2013 and December 2019 was carried out. The change trend of plasma D-dimer of the patients during thrombolysis was statistically analyzed using repeated measures ANOVA. A total of 150 patients were included in the analysis. Among them, 3 days of CDT was ineffective in 41 cases, effective in 33 cases and markedly effective in 76 cases. The plasma D-dimer levels of the patients were significantly different between pre- and post-thrombolysis (F = 23.856, P = 0.000). There was an interaction effect between the measured time factors and thrombolysis efficacy (F=13.991, P=0.000). The change trends of plasma D-dimer levels in the three groups were statistically significant (F = 3.246, P = 0042). The plasma D-dimer level changes regularly during CDT for ALI. We can predict the efficacy of CDT and guide adjustments of the therapeutic regimen according to the trend of D-dimer changes during thrombolysis to obtain better clinical effects.

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The plasma D-dimer trends and their value in acute lower limb ischemia patients treated by catheter directed thrombolysis

Scientific Reports ◽

10.1038/s41598-021-89905-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaochun Liu ◽

Hailiang Xie ◽

Guofu Zheng ◽

Yuanfei Liu

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Time Effect ◽

Repeated Measurements ◽

Spline Regression ◽

Clinical Value ◽

Lower Limb Ischemia ◽

Catheter Directed Thrombolysis ◽

Trends Over Time ◽

D Dimer

AbstractTo investigate the change trends of plasma D-dimer during catheter-directed thrombolysis (CDT) in acute lower limb ischemia (ALI) patients and their clinical value. A retrospective review of patients with ALI who received CDT was carried out. The repeated measurements of plasma D-dimer were analyzed by generalized estimating equations (GEEs) and the change trends of D-dimer were analyzed by spline regression approach. A total of 150 patients were included. Among them, 3 days of CDT was ineffective in 41 cases, effective in 33 cases and markedly effective in 76 cases. The results of GEEs analysis showed that serum D-dimer changed significantly with time (time effect, P < 0.001). Serum D-dimer levels of patients with different treatment outcomes were different after treatment (group effect, P < 0.001), and serum D-dimer levels in these three groups showed different trends over time (group*time effect, P < 0.001). The different trends in serum D-dimer level with time after treatment in the three groups could be directly seen in the spline regression curve (P < 0.001). The plasma D-dimer changes regularly during CDT for ALI. We can predict the efficacy of CDT and guide adjustments of the therapeutic regimen according to the trend of D-dimer changes during thrombolysis.

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COVID-19 Related Acute Lower Limb Ischemia Treated Via Percutaneous Thrombectomy and Catheter Direct Thrombolisis

Angiology & Vascular Surgery ◽

10.24966/avs-7397/100080 ◽

2021 ◽

Vol 6 (3) ◽

pp. 1-7

Author(s):

Francesco De Santis ◽

Keyword(s):

Popliteal Artery ◽

Lower Limb ◽

Mechanical Thrombectomy ◽

Limb Ischemia ◽

High Rate ◽

Lower Limb Ischemia ◽

Percutaneous Mechanical Thrombectomy ◽

Selective Approach ◽

Catheter Directed Thrombolysis ◽

Angio Ct

Background: The aim of this report is to describe and discuss a unique case of acute lower limb ischemia presented in a recovered COVID-19 patient treated via percutaneous mechanical thrombectomy and catheter directed thrombolysis. Starting from this singular case a wide literature review regarding COVID-19-related thrombo-embolic complications has been accomplished. Methods: A 47-year-old male was admitted to the emergency unit with acute lower limb ischemia three weeks after testing positive for COVID-19. He had been isolated at home because of minor COVID-19-related symptoms. Angio-CT-imaging showed a segmental occlusion of the common iliac artery coupled with retro-articular popliteal artery and leg vessels thrombosis. The patient was first unsuccessfully submitted to trans-femoral iliac thrombo-embolectomy. Results: Instead of peripheral limb vessel re-thromboembolectomy, a percutaneous mechanical thrombectomy coupled with leg vessel catheter direct thrombolysis was performed. The completion angiography showed the recanalization of the popliteal artery and leg vessels as far as the ankle but with a reduced forefoot vascularization. The fibrinolytic treatment was continued for 8 hours post-operatively. A compartment syndrome complicated the early post-operative course. There was a progressive recovery of ischemic symptoms and at 6-month follow-up, peripheral pulses were palpable with an almost complete normalization of foot and toe perfusion and motility. Conclusion: Acute lower limb ischemia following COVID-19-related arterial thrombo-embolic events represents a severe complication of COVID-19 infection and may result in a high rate of revascularization failure. In these cases, Percutaneous Mechanical thrombectomy coupled with catheter directed thrombolysis might represent a less traumatic and more selective approach.

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