Efficacy of intra-arterial catheter-directed thrombolysis for popliteal and infrapopliteal acute limb ischemia

Abstract

Objective: The purpose of this study was to examine the efficacy and safety of catheter-directed thrombolysis (CDT) for first-line treatment of popliteal and infrapopliteal acute limb ischemia. Methods: A total of 28 consecutive patients (30 limbs) who underwent CDT for treatment of popliteal and infrapopliteal acute limb ischemia of thromboembolic origin between March 2012 and December 2017 were enrolled in this study. Per the Society for Vascular Surgery, limbs were classified into three runoff score groups: <5, good; 5 to 10, compromised; and >10, poor. The primary end points were primary patency and limb salvage assessed by Kaplan-Meier survival analysis. Secondary end points were technical success and clinical success. The Society for Vascular Surgery-recommended scale for gauging changes in clinical status was used to assess clinical success. Safety of the procedure was evaluated on the basis of periprocedural complications according to the Society of Interventional Radiology classification system. Results: Technical success was achieved in 25 (83.33%) treated limbs. Improved clinical status (grade þ3/þ2) was achieved in 93.33% of limbs. Primary patency and limb salvage for the entire cohort were 76.67% and 90% at 6 months and 60.0% and 76.67% at 12 months, respectively. The patency rate at 6 months and 12 months was 91.67% and 83.33% for the good runoff group, 80% and 60% for the compromised runoff group, and 50% and 25% for the poor runoff group, respectively. The patency rate of the good runoff group was significantly higher compared with that of the poor runoff group (P ¼ .004). Major amputation rate and mortality rate were 16.67% and 7.14%, respectively, at 12 months. The reintervention rate was 3.57% at 6 months and 21.42% at 12 months. Conclusions: CDT is safe and effective for revascularization of smaller vessel acute arterial thromboembolism as a primary therapy. However, more studies with a larger sample are warranted.

Change Trend of Plasma D-Dimer Level and Its Clinical Value in Patients with Acute Lower Limb Ischemia Treated by Catheter-Directed Thrombolysis

“…ALI is caused by a sudden interruption of the main blood perfusion of the lower limb for various reasons, and it usually requires immediate revascularization. CDT has become one of the most commonly used methods for the treatment of ALI 11,12 . After thrombolytic therapy, the vascular stenosis, occlusion and other lesions can be treated simultaneously with interventional therapy, which improves the short-term and long-term patency rate of such occlusive lesions and reduces the need for open surgery in most of these patients 4 .…”

The plasma D-dimer trends and their value in acute lower limb ischemia patients treated by catheter directed thrombolysis

“…ALI is caused by a sudden interruption of the main blood perfusion of the lower limb for various reasons, and it usually requires immediate revascularization. CDT has become one of the most commonly used methods for the treatment of ALI 12 , 13 . After thrombolytic therapy, the vascular stenosis, occlusion and other lesions can be treated simultaneously with interventional therapy, which improves the short-term and long-term patency rate of such occlusive lesions and reduces the need for open surgery in most of these patients 4 .…”

Endovascular revascularization strategies using catheter-based thrombectomy versus conventional catheter-directed thrombolysis for acute limb ischemia

“…Technical success of the primary procedure was defined as complete in situ thrombus clearance of CBT or CDT alone, and adjunctive treatment of CDT to achieve thrombus clearance for CBT was considered to indicate assistant technical success. Clinical success (improvement in clinical status) was defined as the absence and/or relief of symptoms related to ALI according to accepted guidelines [ 5 , 11 ], or an improvement in the Rutherford grade of at least one category with objective evidence of hemodynamic change (at least 0.1 increase in ABI). Limb salvage was defined as freedom from major amputation (performed above the ankle), and maintained functional autonomy (walking or standing) was determined in accordance to accepted guidelines [ 5 ].…”

“…For endovascular approaches, conventional catheter-directed thrombolysis (CDT) is one of the most well established and employed techniques [ 10 , 11 ]. Recently, a variety of new endovascular modalities aimed at mechanical disruption of the thrombus have emerged, and catheter-based thrombectomy (CBT) techniques, including thromboaspiration, microfragmentation, pharmacomechanical thrombectomy and ultrasound-accelerated CDT, have emerged and been made more available [ 12 ].…”