Acute limb deterioration during intra-arterial thrombolysis

Abstract

Approximately 12 per cent of limbs undergoing intra-arterial thrombolysis (IAT) develop distal embolism or extension of thrombus during the procedure. These are usually of little clinical consequence and can be treated by increasing the rate of administration of the lytic agent. However, in some patients the clinical condition of the limb deteriorates rapidly. In an attempt to define the incidence of acute limb deterioration during IAT, information was collected from five centres in the UK with experience of the technique. A total of 866 treatments were recorded, with 20 limbs (2.3 per cent) undergoing acute deterioration. This complication was more common during the treatment of thrombosed popliteal aneurysm than during that of emboli or thrombosed atheromatous arteries or grafts (P < 0.001). The amputation rate associated with the complication was high, and operative intervention provided better results than continuation of lysis.

Management of Popliteal Artery Aneurysms

“…Graft patency depends on many factors. Unfavorable factors with popliteal aneurysm surgery include bypass grafting below the knee and occluded run‐off 25 . However, patency rate was improved by the use of autologous venous conduits and the clearance of calf and digital vessels with trifurcation with or without ankle‐level embolectomy, in the presence of emboli.…”

Intra-Arterial Thrombolysis of Thrombosed Popliteal Artery Aneurysm. A Series of Six Cases

“…A specific technique related complication is fragmentation of the thrombus during lysis, resulting in a transient exacerbation of the ischemic pain (1,6,15). It occurs in up to 13% of the procedures (15). Continuation of the intra-arterial lytic therapy dissolves the disloged fragments of the thrombus, and restores the distal limb perfusion (4, 5) (Fig.…”

“…Therefore, the safety of preoperative fibrinolysis of thrombosed popliteal artery aneurysms is concerning, and rigorous respect of contraindications is mandatory (recent neurologic deficit or stroke within 6 months, recent (4 weeks) surgery, active gastric ulcer) (6,14). A specific technique related complication is fragmentation of the thrombus during lysis, resulting in a transient exacerbation of the ischemic pain (1,6,15). It occurs in up to 13% of the procedures (15).…”

Intravascular fibrinolysis in treating the thromboembolic changes in lower limbs

“…From the clinically significant deterioration of the limb state, resulting from the persistent ischaemia, the passing deterioration of the peripheral parts of the limb, especially the foot, caused by the distal embolization with not entirely dissolved excerpts of thrombus needs to be distinguished. Galland et al [47] consider that maybe it is permanent, but not always clinically visible, part of the thrombolytic treatment. The peripheral micro-embolization arises in a moment when the flow is restored in so far closed vessel.…”