Transcatheter Intraarterial Infusion of rt-PA for Acute Lower Limb Ischemia: Results and Complications

Swischuk, James L.; Fox, Paul F.; Young, Kate; Hussain, Syed Mohammad Asim; Smouse, Bob; Castañeda, Flavio; Brady, Terrence M.

doi:10.1016/s1051-0443(07)61879-x

Cited by 68 publications

(34 citation statements)

References 34 publications

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“…Haemorrhagic complications were neither associated with increased amputation nor mortality rates, suggesting that bleeding should be treated and controlled if possible to avoid discontinuation of thrombolysis. In line with our results, Swischuk et al were able to achieve a favourable amputation-free survival rate [8] despite an even higher haemorrhagic complication rate (47%).…”

Section: Discussionsupporting

confidence: 92%

Risk factors for haemorrhage during local intra-arterial thrombolysis for lower limb ischaemia

Kuoppala

Åkeson

Svensson

et al. 2010

J Thromb Thrombolysis

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Assessment of clinical risk factors for haemorrhagic complications in patients undergoing intra-arterial thrombolysis for lower limb ischaemia. Retrospective reviews of consecutive patients subjected to intra-arterial thrombolysis due to lower limb ischemia at the Vascular Center, Malmö University Hospital, during a 5-year period from 2001 to 2005. Two hundred and twenty intra-arterial thrombolytic procedures were carried out in 195 patients (46% women), median age 73 years. Haemorrhagic complications were recorded in 72 procedures (33%), of which 13 were discontinued. Haemorrhage at the introducer and distant sites occurred in 53 and 32 procedures, respectively. Thrombolysis for occluded synthetic grafts was associated with higher risk of haemorrhage (P = 0.043). The platelet count was lower (P = 0.017) and the dose of alteplas higher (P = 0.041) in bleeders than in non-bleeders. Age was not associated with haemorrhage (P = 0.30). Two patients died during thrombolysis, one of them due to intracerebral haemorrhage. The grade of thrombolysis was an independent predictor of both in-hospital amputation (P < 0.001; OR 3.5 [95% CI 2.1-5.8]) and mortality (P = 0.021; OR 3.0 [95% CI 1.2-7.9]). The in-hospital amputation-free survival rate was 85% (188/220). Haemorrhage associated with thrombolysis is common, but does seldom require discontinuation of treatment. Insertion of introducers for local thrombolysis through synthetic grafts, lower platelet count and higher alteplas dose were found to be risk factors for haemorrhage. An algorithm for clinical management of haemorrhage has been proposed.

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Section: Discussionsupporting

confidence: 92%

Risk factors for haemorrhage during local intra-arterial thrombolysis for lower limb ischaemia

Kuoppala

Åkeson

Svensson

et al. 2010

J Thromb Thrombolysis

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“…Additionally, it is theorized that combination therapy may reduce the rate of major bleeding and intracranial hemorrhage, particularly since this devastating side effect has been rarely observed with GP IIb/IIIa receptor inhibitors. Indeed, Swischuk et al [8] recently reported a 47% major bleeding complication rate using rt-PA infusion rates between 1.5 to 6 mg/hr for an average infusion duration of 28 hr in patients with acute peripheral arterial occlusions. These bleeding complication rates are higher than other trials of intra-arterial rt-PA and may be due to the rather broad definition for a major bleed (any hemorrhagic event leading to surgery, extended or unexpected hospitalization, transfusion, death, intracranial hemorrhage, or a decrease in hematocrit of 15%).…”

Section: Rationale For Combination Therapymentioning

confidence: 99%

Combined glycoprotein IIb/IIIa receptor inhibition and low‐dose fibrinolysis for peripheral arterial thrombosis

Rocha‐Singh

Trokey

2002

Cathet Cardio Intervent

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This feasibility study evaluated the therapeutic potential of combined GP IIb/IIIa receptor inhibition with abciximab and low-dose fibrinolysis with reteplase for treatment of acute femoropopliteal thrombosis. The simultaneous intra-arterial administration of abciximab in conjunction with low-dose reteplase (< or = 0.5 U/hr) was safe in 13 patients; 2 patients experienced major hemorrhagic complication at a reteplase dose of 1 U/hr. The primary success rate was 100%; all patients experienced an excellent clinical response with no clinical evidence of distal embolization. No patient required repeat endovascular or surgical revascularization during mean follow-up of 9.3 months. This promising new thrombolytic strategy for the treatment of peripheral arterial occlusive disease requires further study.

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“…Swischuk et al, had shown the appropriate doses of (TPA) whatever weight-based or non-weight-based and they summerized the appropriate dose from 0.02-0.1mg/kg/h. 16 whereas non-weight-based doses generally ranged from 0.25-1.0mg/h, even though higher doses were reported. However, there were no significant differences between the two groups regarding limb salvage or complication rates.…”

Section: Discussionmentioning

confidence: 98%

Catheter directed thrombolysis in management of early acute thrombotic ischemia: early experience

Ismail

Abdelfattah

2017

Int Surg J

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Background: To assess the effectiveness of catheter directed thrombolysis in management of early acute thrombotic ischemia.Methods: A prospective study was carried out on 18 patients (13 males, 5 females) with a mean age of 49 years (ranged from 45 - 69 years) suffered from acute thrombotic lower limb ischemia (Rutherford II- a) and submitted to catheter directed thrombolysis (CDT) using tissue plasminogen activator (TPA) between August 2015 to March 2017. The commonest thrombosed artery was superficial femoral artery (SFA). Major risk factors were diabetes and smoking (66% and 56%) respectively. The infusion method was lacing technique followed by continuous infusion.Results: Technical success was obtained in 15 patients (83%). Complementary revascularization was performed in 5/15 patients (33.3 %) by balloon angioplasty. Limb salvage rate at 6 months was (77.7%). Failure of thrombolysis occurred in 3 limbs (16.6%); one patient treated by femoro-popliteal bypass while the other two limbs ended by amputation. Regarding complications, bleeding (local groin hematoma or minimal retroperitoneal hematoma) occurred in 3 patients (16.6 %). No major bleeding was recorded. Amputation had performed in 2 cases (11%) while mortality rate within 6 months was 16.6 %.Conclusions: With proper patient selection, CDT should be considered the first-line treatment for patients with (Rutherford II- a) acute thrombotic limb ischemia.

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Transcatheter Intraarterial Infusion of rt-PA for Acute Lower Limb Ischemia: Results and Complications

Cited by 68 publications

References 34 publications

Risk factors for haemorrhage during local intra-arterial thrombolysis for lower limb ischaemia

Risk factors for haemorrhage during local intra-arterial thrombolysis for lower limb ischaemia

Combined glycoprotein IIb/IIIa receptor inhibition and low‐dose fibrinolysis for peripheral arterial thrombosis

Catheter directed thrombolysis in management of early acute thrombotic ischemia: early experience

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