Thrombolysis in peripheral artery disease

Giannakakis, Sotirios; Galyfos, George; Sachmpazidis, Ioannis; Kapasas, Kostas; Kerasidis, Stavros; Stamatatos, Ioannis; Geropapas, Georgios; Kastrisios, Georgios; Papacharalampous, Gerasimos; Maltezos, Chrisostomos

doi:10.1177/1753944716687517

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…19,35–37 Transplantation often results in DGF in these kidneys, 2,6–14,35,36 although a study from the Mayo Clinic, despite a significant difference in vascular resistance and arterial flow at evaluation, no significant difference in DGF was observed, although the control material had 39% and the study group had 49% DGF, that is, higher levels than more commonly reported. 37 Based on these and other studies in experimental animals and humans 21,38–40 as well as our early investigational studies, we selected a combination of Lys-plasminogen and tPA for perfusion and reconditioning of uDCD kidneys. Control uDCD kidneys not treated with Lys-plasminogen frequently appeared dark during perfusion, and sometimes with large black confluent areas suggesting necrosis during and after perfusion.…”

Section: Discussionmentioning

confidence: 99%

Novel Ex-Vivo Thrombolytic Reconditioning of Kidneys Retrieved 4 to 5 Hours After Circulatory Death

et al. 2022

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Background. Due to organ shortage, many patients do not receive donor organs. The present novel thrombolytic technique utilizes organs from donors with uncontrolled donation after circulatory deaths (uDCD), with up to 4–5 h warm ischemia, without advanced cardiopulmonary resuscitation (aCPR) or extracorporeal circulation (EC) after death. Methods. The study group of pigs (n = 21) underwent simulated circulatory death. After 2 h, an ice slush was inserted into the abdomen. Kidneys were retrieved 4.5 h after death. Lys-plasminogen, antithrombin-III (ATIII), and alteplase (tPA) were injected through the renal arteries on the back table. Subsequent ex vivo perfusion at 15 °C was continued for 3 h, followed by 3 h with red blood cells (RBCs) at 32 °C. Perfusion outcome and histology were compared between uDCD kidneys, receiving no thrombolytic treatment (n = 8), and live donor kidneys (n = 7). The study kidneys were then transplanted into pigs as autologous grafts with a single functioning autologous kidney as the only renal support. uDCD control pigs (n = 8), receiving no ex vivo perfusion, served as controls. Results. Vascular resistance decreased to <200 mmHg/mL/min (P < 0.0023) and arterial flow increased to >100 mL/100 g/min (P < 0.00019) compared to controls. In total 13/21 study pigs survived for >10 days, while all uDCD control pigs died. Histology was preserved after reconditioning, and the creatinine level after 10 days was next to normal. Conclusions. Kidneys from extended uDCD, not receiving aCPR/EC, can be salvaged using thrombolytic treatment to remove fibrin thrombi while preserving histology and enabling transplantation with a clinically acceptable early function.

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Section: Discussionmentioning

confidence: 99%

Novel Ex-Vivo Thrombolytic Reconditioning of Kidneys Retrieved 4 to 5 Hours After Circulatory Death

et al. 2022

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“…One group received catheter-directed thrombolysis combined with percutaneous aspiration and, the other, open thrombectomy. In the group with thrombolysis, the patients with graft thrombosis after bypass surgery had better outcomes than those who had thrombosis in vessels [8] . The group of patients who received thrombolysis and percutaneous aspiration had a lower recurrence rate and mortality rate than the group who received open thrombectomies.…”

Section: Discussionmentioning

confidence: 93%

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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“…13 Thrombolysis can be considered for embolic disease in ALI, Rutherford class I or class IIa. 14 However, the mechanism of aortic occlusion has trended toward thrombotic events, decreasing from 50% to 68% embolic in the 1990s 3,13,15 to 7% embolic, 17% indeterminate, and 76% thrombotic in 2013. 2 Improved anticoagulation for atrial fibrillation 16 has possibly decreased the incidence of embolic aortic occlusions.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous recanalization of a total occlusion of an infrarenal abdominal aorta after left axillary-bifemoral bypass

Choinski

Wood

Korayem

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Acute aortic occlusion is an infrequent clinical event with high morbidity and mortality. Management is determined by the cause of the occlusion, with thromboembolectomy used for embolic events and bypass for thrombotic events. After bypass, recanalization of a total aortic occlusion has been sparsely reported. We present a case of a total occlusion of an infrarenal abdominal aorta that was managed surgically with a left axillary-bifemoral bypass. Imaging performed 6 months postoperatively revealed a spontaneously recanalized aorta and occluded bypass graft.

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Thrombolysis in peripheral artery disease

Cited by 11 publications

References 28 publications

Novel Ex-Vivo Thrombolytic Reconditioning of Kidneys Retrieved 4 to 5 Hours After Circulatory Death

Novel Ex-Vivo Thrombolytic Reconditioning of Kidneys Retrieved 4 to 5 Hours After Circulatory Death

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

Spontaneous recanalization of a total occlusion of an infrarenal abdominal aorta after left axillary-bifemoral bypass

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