Catheter directed thrombolysis in management of early acute   thrombotic ischemia: early experience

Background: To assess the effectiveness of catheter directed thrombolysis in management of early acute thrombotic ischemia.Methods: A prospective study was carried out on 18 patients (13 males, 5 females) with a mean age of 49 years (ranged from 45 - 69 years) suffered from acute thrombotic lower limb ischemia (Rutherford II- a) and submitted to catheter directed thrombolysis (CDT) using tissue plasminogen activator (TPA) between August 2015 to March 2017. The commonest thrombosed artery was superficial femoral artery (SFA). Major risk factors were diabetes and smoking (66% and 56%) respectively. The infusion method was lacing technique followed by continuous infusion.Results: Technical success was obtained in 15 patients (83%). Complementary revascularization was performed in 5/15 patients (33.3 %) by balloon angioplasty. Limb salvage rate at 6 months was (77.7%). Failure of thrombolysis occurred in 3 limbs (16.6%); one patient treated by femoro-popliteal bypass while the other two limbs ended by amputation. Regarding complications, bleeding (local groin hematoma or minimal retroperitoneal hematoma) occurred in 3 patients (16.6 %). No major bleeding was recorded. Amputation had performed in 2 cases (11%) while mortality rate within 6 months was 16.6 %.Conclusions: With proper patient selection, CDT should be considered the first-line treatment for patients with (Rutherford II- a) acute thrombotic limb ischemia.

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The Role of Catheter Directed Thrombolysis on Acute Limb Ischemia (an Evidence-Based Case Report)

Jurnal llmu Bedah Indonesia ◽

10.46800/jibiikabi.v49i1.79 ◽

2021 ◽

Vol 49 (1) ◽

pp. 3-24

Author(s):

Ali Farhan Fathoni ◽

Raden Suhartono

Keyword(s):

Case Report ◽

Adult Patient ◽

Controlled Trial ◽

Limb Ischemia ◽

Evidence Based ◽

Acute Limb Ischemia ◽

First Line ◽

Bleeding Events ◽

Catheter Directed Thrombolysis ◽

Significant Difference

Introduction. Acute limb ischemia can be managed both with surgery and thrombolysis, especially catheter-directed thrombolysis. The risk, benefit and indication of thrombolysis is already well known. However, as a first line therapy, it is unclear which intervention is more beneficial; the catheter directed thrombolysis or surgery. This report aims to elucidate which technique is more effective and safer. Method. This is an Evidence-Based Case Report based on a case of a geriatric, diabetic patient whom suffered acute limb ischemia. The report systematically search for meta-analysis, systematic review, randomized controlled trial and cohort studies from Cochrane central and PubMed for all adult patient suffering from acute limb ischemia whose are treated with catheter-directed thrombolysis or surgery as first-line intervention and comparing the outcome in terms of efficacy (clinical outcome such as patency and amputation-free rates) and safety (mortality and morbidity). Results. Subjects’ characteristics should be placed first to draw the demography. Put the study finding(s) here with no interpretation. For all adult patient regardless of their diabetic status and age there is no statistically significant difference for limb salvage, amputation, and mortality between two technique, however catheter directed thrombolysis showed reduced need for additional intervention whilst increasing risk of bleeding events. Conclusion. Neither techniques are more superior than the other but catheter-directed thrombolysis can be considered given that it reduce the need for further intervention, less invasive and even though it has risks for bleeding complication it is still lower compared to systemic thrombolysis. The selection of which technique can be up to clinician’s discretion in consideration of risk and benefit for each patient.

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Aspiration Thrombectomy versus Conventional Catheter-Directed Thrombolysis as First-Line Treatment for Noniatrogenic Acute Lower Limb Ischemia

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2017.11.030 ◽

2018 ◽

Vol 29 (5) ◽

pp. 607-613 ◽

Cited By ~ 11

Author(s):

C.H. Ricky Kwok ◽

Scott Fleming ◽

Kenneth K.C. Chan ◽

Jonathan Tibballs ◽

Shaun Samuelson ◽

...

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Line Treatment ◽

First Line ◽

Aspiration Thrombectomy ◽

Lower Limb Ischemia ◽

Catheter Directed Thrombolysis ◽

First Line Treatment

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Hybrid Technique for Acute on chronic Lower Limb Ischemia, A single centre study

QJM ◽

10.1093/qjmed/hcab092.001 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Islam Badry Mohammed ◽

Amr Nabil Kamel ◽

Mohammed Mahmoud Zaki

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Hybrid Procedure ◽

Hybrid Technique ◽

Technical Success ◽

Hybrid Procedures ◽

Lower Limb Ischemia ◽

Single Centre Study ◽

One Step ◽

Salvage Rate

Abstract Background Several methods have been postulated for the treatment of acute on chronic lower limb ischemia; among them, the hybrid procedure (combined open thrombectomy and angioplasty) is gaining popularity .It is aimed at clearing the vessel and treating the underlying vessel lesion in one step. Patients and Methods A total of 23 patients admitted to the vascular department were eligible for inclusion in this study. They were subjected to thromboembolectomy, followed by endovascular balloon dilatation with or without stenting. Data regarding the risk factors, procedure success, and complications were recorded. Results Hybrid procedures showed 91.6% immediate technical success and 82.6% primary limb salvage rate up to 6 months with accepted minor complications. and no major complications Conclusion The hybrid procedure provides an accepted outcome in treating immediately limb- threatening acute on chronic lower limb ischemia.

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A Case of Needle-Directed Pulse-Spray Pharmacomechanical Thrombolysis of Acute Brachial Artery Thrombosis

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-3401326 ◽

2019 ◽

Vol 03 (03) ◽

pp. 193-195

Author(s):

Yugandhar Samireddypalle ◽

Uma Maheshwara Reddy V. ◽

Chinmay Deepak ◽

Sankar Neelakantan ◽

Amitha Vikrama KS

Keyword(s):

Brachial Artery ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

First Line ◽

Management Options ◽

Artery Thrombosis ◽

Catheter Directed Thrombolysis ◽

Symptoms And Signs

AbstractAcute limb ischemia is a serious disabling condition. The management options depend upon the patient symptoms and signs of ischemia in the affected limb. The management options include surgical thrombo-embolectomy and catheter directed thrombolysis. Catheter directed thrombolysis has now become the first line of management in symptomatic cases. Here, we discuss a case of acute left brachial artery thrombosis which was successfully managed by needle-directed pulse-spray thrombolysis.

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Protocoled thrombolytic therapy for frostbite improves phalangeal salvage rates

Burns & Trauma ◽

10.1093/burnst/tkaa008 ◽

2020 ◽

Vol 8 ◽

Author(s):

Rosemary Elizabeth Paine ◽

Elizabeth Noel Turner ◽

Daniel Kloda ◽

Carolyne Falank ◽

Bruce Chung ◽

...

Keyword(s):

Thrombolytic Therapy ◽

Inclusion Criteria ◽

Treatment Practices ◽

Tissue Plasminogen ◽

Promising Treatment ◽

Considerable Morbidity ◽

Groin Hematoma ◽

Salvage Rate ◽

Optimal Treatment Strategy

Abstract Background Frostbite is a cold injury that has the potential to cause considerable morbidity and long-term disability. Despite the complexity of these patients, diagnostic and treatment practices lack standardization. Thrombolytic therapy has emerged as a promising treatment modality, demonstrating impressive digit salvage rates. We review our experience with thrombolytic therapy for severe upper extremity frostbite. Methods Retrospective data on all frostbite patients evaluated at our institution from December 2017 to March 2018 was collected. A subgroup of patients with severe frostbite treated with intra-arterial thrombolytic therapy (IATT) were analysed. Results Of the 17 frostbite patients treated at our institution, 14 (82%) were male and the median age was 31 (range: 19–73). Substance misuse was involved in a majority of the cases (58.8%). Five (29.4%) patients with severe frostbite met inclusion criteria for IATT and the remaining patients were treated conservatively. Angiography demonstrated a 74.5% improvement in perfusion after tissue plasminogen activator thrombolysis. When comparing phalanges at risk on initial angiography to phalanges undergoing amputation, the phalangeal salvage rate was 83.3% and the digit salvage rate was 80%. Complications associated with IATT included groin hematoma, pseudoaneurysm and retroperitoneal hematoma. Conclusions Thrombolytic therapy has the potential to greatly improve limb salvage and functional recovery after severe frostbite when treated at an institution that can offer comprehensive, protocoled thrombolytic therapy. A multi-center prospective study is warranted to elucidate the optimal treatment strategy in severe frostbite.

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Comparison of Ultrasound-Accelerated Versus Multi-Hole Infusion Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia

Vascular and Endovascular Surgery ◽

10.1177/1538574419861768 ◽

2019 ◽

Vol 53 (7) ◽

pp. 558-562 ◽

Cited By ~ 2

Author(s):

Jesse Chait ◽

Afsha Aurshina ◽

Natalie Marks ◽

Anil Hingorani ◽

Enrico Ascher

Keyword(s):

Success Rate ◽

Limb Ischemia ◽

Limb Loss ◽

Acute Limb Ischemia ◽

Technical Success ◽

Safety And Efficacy ◽

Technical Success Rate ◽

Infusion Catheter ◽

Catheter Directed Thrombolysis ◽

The Mean

Objective: Thrombolytic therapy is widely used in the treatment of arterial occlusions causing acute limb ischemia (ALI); however, knowledge regarding the efficacy of the different catheter systems available is scarce. The objective of this study was to compare the safety and efficacy of 2 catheter-directed infusion systems for intra-arterial thrombolysis in the setting of ALI. Methods: A retrospective analysis was conducted to study all catheter-directed thrombolysis procedures performed over 32 months in patients diagnosed with ALI. Patients with thrombosis in both native arteries and bypass grafts were included. Patients with contraindications to thrombolysis, or those receiving thrombolysis for deep venous thrombosis, were excluded. The duration of thrombolysis, amount of thrombolytic agent, and technical success rate were recorded. Technical success was defined as complete or near-complete resolution of thrombus burden, allowing for further intervention. Data were stratified to include location of thrombus, procedural complications, mortality, and rates of limb loss. Results: Ninety-one patients met inclusion criteria. Among them, Uni-Fuse and EKOS catheters were used in 69 and 22 patients, respectively. The mean age of the population was 71 (standard deviation [SD]: ±1.5) for patients treated with the EKOS catheter and 70 years (SD: ±2.6) for patients receiving thrombolysis with Uni-Fuse. There was no significant difference in the mean infusion duration (1.65 vs 1.9 days), volume of tissue plasminogen activator (44.6 vs 48.2 mg), or technical success rate (72% vs 86%) between the Uni-Fuse and EKOS cohorts ( P > .3). Furthermore, there was no difference in major limb loss or compartment syndrome between each group ( P > .4). The overall complication rate was 14% in both groups, with a 30-day mortality rate of 4% when treated with either catheter system. Conclusion: This study suggests that a standard multi-hole infusion catheter demonstrates similar clinical safety and efficacy as the ultrasound-accelerated EKOS system in the treatment of ALI.

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

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2003)010<0739:pbfhth>2.0.co;2 ◽

2003 ◽

Vol 10 (4) ◽

pp. 739-744 ◽

Cited By ~ 1

Author(s):

Dimitrios K. Tsetis ◽

Asterios N. Katsamouris ◽

Athanasios D. Giannoukas ◽

Adam A. Hatzidakis ◽

Theodoros Kostas ◽

...

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

High Dose ◽

Lower Limb Ischemia ◽

Catheter Directed Thrombolysis ◽

Potential Benefits

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Clinical outcomes of surgical embolectomy versus catheter-directed thrombolysis for acute limb ischemia: a nationwide cohort study

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-021-02532-1 ◽

2021 ◽

Author(s):

Po-Kai Yang ◽

Chien-Chou Su ◽

Chih-Hsin Hsu

Keyword(s):

Rate Ratio ◽

Surgical Intervention ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Antithrombotic Agent ◽

Catheter Directed Thrombolysis ◽

Significant Difference ◽

Surgical Embolectomy ◽

Adjusted Rate ◽

Adjusted Rate Ratio

AbstractIn Taiwan, the outcomes of acute limb ischemia have yet to be investigated in a standardized manner. In this study, we compared the safety, feasibility and outcomes of acute limb ischemia after surgical embolectomy or catheter-directed therapy in Taiwan. This study used data collected from the Taiwan’s National Health Insurance Database (NHID) and Cause of Death Data between the years 2000 and 2015. The rate ratio of all-cause in-hospital mortality and risk of amputation during the same period of hospital stay were estimated using Generalized linear models (GLM). There was no significant difference in mortality risk between CDT and surgical intervention (9.5% vs. 10.68%, adjusted rate ratio (95% CI): regression 1.0 [0.79–1.27], PS matching 0.92 [0.69–1.23]). The risk of amputation was also comparable between the two groups. (13.59% vs. 14.81%, adjusted rate ratio (95% CI): regression 0.84 [0.68–1.02], PS matching 0.92 [0.72–1.17]). Age (p < 0.001) and liver disease (p = 0.01) were associated with higher mortality risks. Heart failure (p = 0.03) and chronic or end-stage renal disease (p = 0.03) were associated with higher amputation risks. Prior antithrombotic agent use (p = 0.03) was associated with a reduced risk of amputation. Both surgical intervention and CDT are effective and feasible procedures for patients with ALI in Taiwan.

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