Outcome after Preoperative or Intraoperative Use of Intra-arterial Urokinase Thrombolysis for Acute Popliteal Artery Thrombosis and Leg Ischemia

Gabrielli, Roberto; Rosati, Maria Sofia; Carra, Alessandro; Vitale, Silvio; Siani, Andrea

doi:10.1055/s-0034-1378189

Cited by 4 publications

(4 citation statements)

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“…28 Concerning acute popliteal artery aneurysm thrombosis and leg ischemia, a study analyzed the outcomes of preoperative and intraoperative use of intra-arterial thrombolysis reporting 30-day amputation rates of 18% and 29%, respectively. 7 Leak et al reported on 186 popliteal aneurysms (110 OR, 76 ER). OR was performed in more patients with thrombosis (41.8% vs 5.3%; p < .001), acute ischemia (24.5% vs 9.2%; p < .010), and ischemic rest pain (34.5% vs 6.6%; p < .001).…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Moreover, studies reporting on the use of fibrinolysis in the acute treatment of PAA have been published. 7 Recent guidelines from the Society of Vascular Surgery recommend a stratification of thrombotic or embolic complications of PAA depending on the severity of ischemia at presentation to decide if a thrombolysis or pharmacomechanical intervention should be performed. 8 Only one randomized controlled trial exists comparing OR with ER for elective asymptomatic PAA.…”

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confidence: 99%

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Emergency treatment of popliteal aneurysms: Single center experience and systematic review and meta-analysis of endovascular versus open repair

et al. 2022

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Background Popliteal artery aneurysms (PAA) were traditionally treated by open repair (OR). Endovascular repair (ER) has become a new treatment strategy. The aim of this systemic review and meta-analysis was to evaluate and compare the current outcomes of OR and ER in the emergency treatment of PAA. Methods A systematic literature search of the PubMed/Medline database was carried out. Outcomes were 30-day mortality, morbidity, major amputation rate (30 days), major amputation rate (1 year), 1-year primary patency rate, 1-year secondary patency rate and 1-year survival. Additionally, we included clinical data of patients with popliteal aneurysms treated between 2009 and 2021 at the Martin-Luther University Halle-Wittenberg. Results We identified two cohort studies from 2014 and 2015 with a total of 199 patients that underwent emergent surgery (39 ER and 160 OR). We also included 26 patients from our institution. For emergency treatment, 30-day major amputation rates (18% vs 3%, Odds Ratio 5.82, 95% CI [1.75; 19.30], p = .004), 30-day mortality rates (10% vs 1%, Odds Ratio 5.57, 95% CI [1.01; 30.58], p = .05), 1-year major amputation rates (15% vs 6% Odds Ratio 3.61, 95% CI [1.18; 11.09], p = .02), 1-year loss of primary patency (54% vs 23%, Odds Ratio 3.19, 95% CI [0.91; 11.20], p = .07), and 1-year loss of secondary patency (44% vs 12%, Odds Ratio 6.91, 95% CI [3.01; 15.83], p < .05) were higher in the ER group when compared to the OR group. Conclusion Endovascular repair represents an alternative approach for the emergency treatment of PAA. Limited evidence from the available non-randomized studies shows unfavorable outcomes for patients undergoing ER. However, the results are prone to selection bias, and only randomized trials comparing ER to OR might reveal whether a subgroup of patients would benefit from ER as primary treatment of PAA in an emergency setting.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Emergency treatment of popliteal aneurysms: Single center experience and systematic review and meta-analysis of endovascular versus open repair

et al. 2022

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“…There are 3 generations of thrombolytic agents: the first (streptokinase, urokinase), the second (alteplase and pro-urokinase), and the third (reteplase, tenecteplase, and staphylokinase). Even though streptokinase, urokinase, and alteplase are frequently used inperipheral arterial diseases, recent guidelines recommend the last 2 thrombolytics [9] , [10] - 11] !. The treatment dose of alteplase is a bolus of 1-2 mg followed by infusion of 0.05 mg/kg/h and 10,000 UI of intravenous heparin per 24 hours.…”

Section: Discussionmentioning

confidence: 99%

Catheter-directed intra-arterial thrombolysis in the treatment of acute thrombosis of below-the-knee arteries

Luan

Bang

Tan

et al. 2021

Radiology Case Reports

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Selecting treatment options in acute arterial thrombosis of the lower extremity, which threatens limb viability, is still a challenge for vascular surgeons. Early restoration of blood flow is crucial and is conducted by surgical thrombectomies or endovascular procedures, depending on patient condition. Catheter-directed thrombolysis with or without percutaneous mechanical thrombectomy for acute limb ischemia has been widely implemented from the early 1990s. Here, we present 2 cases of acute thrombosis of below-the-knee arteries, where we successfully saved the involved limbs using catheter-directed thrombolysis and thrombus aspiration.

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“…Common thrombolytic agents include first generation agents, such as streptokinase and urokinase, second generation agents, such as tissue plasminogen activator (tPA) and pro urokinase, and third generation agents, including reteplase, tenecteplase and Staphylokinase. Thrombolytic agents utilized in the treatment of peripheral arteries disease include streptokinase and urokinase as well as, currently, alteplase (15) .…”

Section: Thrombolytic Agent Practical Definitionmentioning

confidence: 99%

Investigating the Nurses and Doctors Attitudes' Regarding the Management of Acute Myocardial Infarction Patients Who Used the Thrombolytic Agents in Babylon Teaching Hospitals 2022rses and Doctors Regarding Management of Patients with Acute Myocardial Infarction Using Thrombolytic Agents in the Teaching Hospitals of Babylon, Iraq in 2022

Al-Ameri,

Al-Jumaili,

Rad

2024

Kufa Jour. Nurs. Sci.

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Introduction and purpose: Ischemic heart disease and myocardial infarction are the most common causes of death in the world, and nurses play a key role in the management of these patients. Adequate attitude of health care workers towards the management of patients with acute myocardial infarction using thrombolytic agents is very important and this issue is part of patients' rights. Aims: The present study was conducted with the aim of study investigate the attitude of nurses and doctors regarding the management of patients with acute myocardial infarction using thrombolytic agents in the teaching hospitals of Babylon, Iraq in 2022. Research method: In this comparative study, 103 nurses and 13 doctors were selected in 2022 by available sampling method the type of sample was purposive and was conducted on nurses and doctors working in cardiac and coronary resuscitation units in Babylon Specialized Hospitals. Information was collected using two questionnaires including demographic questionnaire and attitude measurement questionnaire the attitudes questionnaire contained parts that included nurses and doctors, and a section specific to nurses only. Results: Among the studied nurses, the largest number were university nurses (36.9% bachelor, 8.7% master). (89.3%) of the nurses had work experience in the coronary care department and (73.8%) of them were currently working in the coronary care department. (78.6%) worked in the morning shift. (76.7%) of the nurses did not have a history of passing the training course in the coronary care department. (54.4%) of the nurses have a diploma and only (2.9%) of them have completed an academic course. The score of doctor’s attitude about the management of patients with acute myocardial infarction using thrombolytic agents was in the range of 68 to 98 with a mean and standard deviation of 83.62 ± 9.62. Based on the results of the independent t-test, there was no significant difference between nurses and doctors regarding the management of patients with acute myocardial infarction using thrombolytic agents (p=0.210). Conclusion: The study concludes that both nurses and doctors in Babylon Teaching Hospitals show a positive attitude towards managing acute myocardial infarction patients using thrombolytic agents. Despite variations in experience and training, both groups are prepared to provide effective care for these patients. The findings suggest a readiness within the medical staff to handle cases of AMI with thrombolytic therapy, highlighting the importance of continued education and training in coronary care management.

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Outcome after Preoperative or Intraoperative Use of Intra-arterial Urokinase Thrombolysis for Acute Popliteal Artery Thrombosis and Leg Ischemia

Abstract: Our results suggest that the immediate surgery with intraoperative thrombolysis improved the outcome of patients with acute leg ischemia due to PAA thrombosis in terms of limb salvage.

Cited by 4 publications

References 20 publications

Emergency treatment of popliteal aneurysms: Single center experience and systematic review and meta-analysis of endovascular versus open repair

Emergency treatment of popliteal aneurysms: Single center experience and systematic review and meta-analysis of endovascular versus open repair

Catheter-directed intra-arterial thrombolysis in the treatment of acute thrombosis of below-the-knee arteries

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