Bleeding complications at the access sites during catheter directed thrombolysis for acute limb ischaemia: Mini review

Acute and subacute ischemia of the lower limbs represents a major emergency with a high in-hospital mortality, complication, and leg amputation rates. Treatment options for acute limb ischemia include systemic anticoagulation, followed by various catheter based options including infusion of fibrinolytic agents (pharmacological thrombolysis), pharmacomechanical thrombolysis, catheter-mediated thrombus aspiration, mechanical thrombectomy, and any combination of the above or open surgical intervention (thromboembolectomy or surgical bypass). Minor and major bleeding complication during catheter directed thrombolysis (CDT) especially at access site are frequent. Bleeding complications require often an interruption or termination of CDT affecting clinical outcome of the patients. Recently we examined a new access site bleeding protection device during CDT.

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Treatment of acute limb ischemia with focus on endovascular techniques

VASA ◽

10.1024/0301-1526.38.2.123 ◽

2009 ◽

Vol 38 (2) ◽

pp. 123-134 ◽

Cited By ~ 10

Author(s):

Zeller ◽

Tepe

Keyword(s):

Randomized Trials ◽

Mechanical Thrombectomy ◽

Clinical Presentation ◽

Patient Survival ◽

Treatment Options ◽

Limb Ischemia ◽

Bleeding Complications ◽

Acute Limb Ischemia ◽

Endovascular Techniques ◽

Local Lysis

Acute limb ischemia is still the most frequent cause of major limb loss. Timely and fast revascularization is the key for limb salvage and patient survival. Large randomized trials showed equivalency of surgical and endovascular revascularization by means of local lysis with urokinase (TOPAS, STILE). New lytic agents and their modified application such as via a pulse spray catheter or combined with an ultrasound catheter and the combination with glycoprotein IIb/IIIa receptor antagonists have increased the efficacy and speed of thrombolysis. Recently, mechanical thrombectomy devices have become more widespread because intervention time and bleeding complications can be reduced. This review article summarizes the clinical presentation of and the treatment options for acute arterial occlusive disease caused either by embolism or local thrombosis.

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Current Treatment Options in Acute Limb Ischemia

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-0998-4204 ◽

2019 ◽

Vol 192 (04) ◽

pp. 319-326

Author(s):

Friederika Fluck ◽

Anne Marie Augustin ◽

Thorsten Bley ◽

Ralph Kickuth

Keyword(s):

Treatment Time ◽

Treatment Options ◽

Limb Ischemia ◽

Current Treatment ◽

Acute Ischemia ◽

Symptom Duration ◽

Acute Limb Ischemia ◽

Arterial Embolism ◽

Duration Of Symptoms ◽

Catheter Directed Thrombolysis

Background Acute limb ischemia represents a clinical emergency with eventual limb loss and life-threatening consequences. It is characterized by a sudden decrease in limb perfusion. Acute ischemia is defined as a duration of symptoms for less than 14 days. Aging of the population increases the prevalence of acute limb ischemia. The two principal etiologies are arterial embolism and in situ thrombosis of an atherosclerotic artery. Immediate diagnosis, accurate assessment and urgent intervention when needed are crucial to save the limb and to prevent a major amputation. Delay in diagnosis and therapy may lead to irreversible ischemic damage. Method To assess the current treatment options in acute limb ischemia, this review is based on a selective literature search in PubMed representing the current state of research. Results and Conclusion Patients with acute limb ischemia should receive immediate anticoagulation. Treatment depends on the classification based on the degree of ischemia and limb viability. Especially acute (< 14 days symptom duration) Rutherford Categories IIa and IIb with marginally and immediately threatened limbs require definitive therapeutic intervention and are salvageable, if promptly revascularized. The current literature suggests that open surgical revascularization is more time effective then catheter-directed thrombolysis. However, with the advent of thrombolytic delivery systems and mechanical thrombectomy devices, treatment time can be minimized and successful utilization in patients with Category IIb (Rutherford Classification for Acute Limb Ischemia) has been reported with promising limb-salvage and survival rates. Large randomized studies are still missing, and guidelines suggest choosing the method of revascularization depending on anatomic location, etiology, and local practice patterns, with the time to restore the blood flow being an important factor to consider. Key points: Citation Format

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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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RR20. Ultrasound-Accelerated Thrombolysis is Superior to Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.03.206 ◽

2011 ◽

Vol 53 (6) ◽

pp. 106S-107S

Author(s):

Maria E. Litzendorf ◽

Jean E. Starr ◽

Bhagwan Satiani ◽

Katherine E. Notter

Keyword(s):

Limb Ischemia ◽

Acute Limb Ischemia ◽

Catheter Directed Thrombolysis

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Catheter directed thrombolysis for acute limb ischemia: eight cases in two years

Cardiologia Croatica ◽

10.15836/ccar.2014.185 ◽

2014 ◽

Vol 9 (5-6) ◽

pp. 185-185

Author(s):

Majda Vrkic Kirhmajer ◽

Ljiljana Banfic ◽

Kresimir Putarek ◽

Miroslav Krpan ◽

Savko Dobrota ◽

...

Keyword(s):

Limb Ischemia ◽

Acute Limb Ischemia ◽

Catheter Directed Thrombolysis

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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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