Document Detail


Is initial success of thrombolytic therapy with rt-PA in patients with lower limb ischemia durable? A long-term follow-up series.
MedLine Citation:
PMID:  17708103     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Catheter-directed intraarterial thrombolytic therapy with rt-PA has been established as an alternative to surgery in selected patients with lower limb ischemia. The purpose of this study is to evaluate its long-term results and to try to identify patient variables influencing outcome.
PATIENTS AND METHODS: The results of thrombolytic treatment for acute or subacute lower limb ischemia in 82 patients (51 male, 31 female) were retrospectively analysed. Clinical data (time of symptoms onset, clinical stage, type of affected vessel, anatomical localisation) as well as comorbidities were recorded. The success rate of thrombolysis as well as the incidence of adverse events was evaluated. Patients with initial success were followed up after a median of 52,5 months.
RESULTS: Thrombolytic therapy was successful in 67 cases (82%). An additional endovascular or surgical procedure was necessary in 39 of these patients (48%). The overall bleeding rate was 18% and the mortality and major amputation rate was 1%. 42 patients with early clinical success were available for follow-up. 34 of them (81%) were free of ischemic symptoms and the overall limb salvage rate was 96%. We could not identify factors significantly influencing early or long-term results, although there was a trend towards better results in patients with acute ischemia and in patients with occluded native arteries.
CONCLUSIONS: Intraarterial local thrombolytic therapy has a relatively high initial success rate in selected patients with lower limb ischemia, but is associated with a significant number of bleeding complications. Furthermore, additional procedures are required in almost half the patients. Initial success is durable at the long-term in the majority of cases. Better selection of patients and refinements of the thrombolytic therapy might help to further improve results and lower the bleeding complications.
Authors:
B Geier; A Mumme; O Köster; B Marpe; T Hummel; G Asciutto
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  VASA. Zeitschrift für Gefässkrankheiten     Volume:  36     ISSN:  0301-1526     ISO Abbreviation:  VASA     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-08-21     Completed Date:  2007-10-18     Revised Date:  2012-10-19    
Medline Journal Info:
Nlm Unique ID:  0317051     Medline TA:  Vasa     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  114-20     Citation Subset:  IM    
Affiliation:
Klinik für Gefässchirurgie, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Germany. Bruno.Geier@rub.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angiography, Digital Subtraction
Blood Vessel Prosthesis
Female
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Graft Occlusion, Vascular / drug therapy,  radiography
Humans
Ischemia / drug therapy*,  radiography
Leg / blood supply*
Male
Middle Aged
Retrospective Studies
Thrombolytic Therapy*
Tissue Plasminogen Activator / therapeutic use*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator

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