Document Detail


Single center experience with provisional abciximab therapy in complex lower limb interventions.
MedLine Citation:
PMID:  18690593     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Abciximab, a glycoprotein IIb/IIIa antagonist has been shown to improve patency and clinical outcome in patients undergoing endovascular recanalization of femoro-popliteal occlusions. However, data on abciximab therapy in complex peripheral catheter interventions of lower limbs are quite limited. The objective of this retrospective study was to evaluate the clinical and hemodynamic outcomes of patients treated with provisional abciximab during complex peripheral catheter interventions.
PATIENTS AND METHODS: Analysis of a consecutive series of 44 patients with provisional abciximab therapy in complex peripheral catheter interventions with imminent risk of early rethrombosis defined as revascularization of arterial occlusions associated with one or more of the following additional circumstances named as time-consuming intervention > 3 hours, compromised contrast flow not solved by stenting, distal embolization not solved by mechanical thromboembolectomy, and peri-interventional notice of thrombus evolution despite adequate heparin adjustment of lower limbs. Adjunctive abciximab therapy was started in accordance to percutaneous coronary bailout situations. The decision to add abciximab was based on the decision of the operator and went along with the judgement that there is a rising risk of reocclusion due to the progressive complexity of an individual intervention. A bolus of 0.25 mg per kilogram of body weight, followed by a maintenance infusion of 0.125 microg/kg/min (up to a maximum dosage of 10 microg/min) for 12 hours was administered. Clinical and hemodynamic outcome was prospectively assessed at discharge, three and six months after the index procedure.
RESULTS: The occluded artery of 44 limbs was in the iliac (2%), in the femoro-popliteal (73%) or below the knee segment (25%). Overall, occlusion length was 11.5 +/- 6.5 cm. Technical success rate was 95%. Mean ABI increased from 0.5 +/- 0.16 to 0.88 +/- 0.19 (p < 0.001) with immediate hemodynamic improvement of 91%. Overall, sustained clinical improvement was 84% and 66% at three and six months follow-up, with best results in iliac (100%), followed by below the knee (73%) and by femoro-popliteal segment (63%) at six months, respectively. Overall, secondary clinical improvement was 86% at six months. Minor and major bleeding complications were 16% and 9%, respectively.
CONCLUSION: Abciximab should be noticed as medical adjunct in the interventional armamentarium to prevent imminent rethrombosis in complex peripheral catheter interventions.
Authors:
H Keo; N Diehm; R Baumgartner; M Husmann; I Baumgartner
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  VASA. Zeitschrift für Gefässkrankheiten     Volume:  37     ISSN:  0301-1526     ISO Abbreviation:  VASA     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-11     Completed Date:  2008-10-16     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  0317051     Medline TA:  Vasa     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  257-64     Citation Subset:  IM    
Affiliation:
Swiss Cardiovascular Center, Division of Angiology, Inselspital Bern, University Hospital and University of Bern, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Antibodies, Monoclonal / adverse effects,  therapeutic use*
Arterial Occlusive Diseases / drug therapy*,  physiopathology,  surgery
Female
Hemodynamics / drug effects
Hemorrhage / chemically induced
Humans
Immunoglobulin Fab Fragments / adverse effects,  therapeutic use*
Lower Extremity / blood supply*
Male
Middle Aged
Peripheral Vascular Diseases / drug therapy*,  physiopathology,  surgery
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use*
Recurrence / prevention & control
Retrospective Studies
Time Factors
Treatment Outcome
Vascular Surgical Procedures* / adverse effects
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; X85G7936GV/abciximab

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