Catheter Directed Thrombolysis in Management of Acute Thrombotic Lower Limb Ischemia

Abstract

Background: Acute limb ischemia is a limb threatening condition that require wise decision making to achieve limb salvage. Aim of Study: To evaluate the safety, efficacy and outcome of catheter directed thrombolysis (CDT) in management of acute thrombotic lower limb ischemia. Patients and Methods: 20 patients suffering from acute limb ischemia (ALI) due to infrainguinal arterial thrombosis were submitted to catheter directed thrombolysis under fluoroscopic guidance, treated by Actilyse "tissue plasminogen activator" during the period from April 2017 to April 2018, outcome was assessed by angiographic imaging "technical success" and clinical improvement "clinical success". Results: Overall thrombolysis success and limb salvage were achieved in 16 patients (80%), major amputation was performed in 4 cases (20%), surgical interference "thrombectomy" was needed in 2 cases (10%), complementary balloon angioplasty was done in 4 cases (20%). Regarding complications, peri-sheath hematoma was observed in 5 patients (25%), one case developed compartment syndrome (5%), epistaxis in 2 cases (10%) and hematuria in 3 cases (15%), no mortality recorded during hospital stay or two weeks follow-up. Conclusion: Catheter directed intra-arterial thrombolysis is a safe, effective management for thrombotic etiology of ALI.