Transcatheter therapy of severe acute lower extremity ischemia.
OBJECTIVE
Transcatheter methods of revascularization were performed in 11 patients with severe acute lower extremity ischemia and extensive vascular occlusions in whom surgical revascularization was not possible (10 patients) or was not preferred (one patient).


METHODS
The acute ischemia was considered category 2 in nine patients and category 3 in two. Vascular occlusions were located in the superficial femoral artery in four patients, popliteal artery in 10, all three crural arteries in 10, and two crural arteries in one. Transcatheter methods included accelerated thrombolysis with 325,000 to 1.75 million U of urokinase, adjunct angioplasty, use of intraarterial vasodilators, and creation of pedal arterial flow loops.


RESULTS
Initial success was 100% in the nine patients with category 2 ischemia. Eight limbs were saved; one occlusion at 10 days necessitated below-knee amputation. For the two patients with category 3 ischemia, one procedure failed and the other reduced the level of amputation.


CONCLUSIONS
In patients with severe acute ischemia, transcatheter revascularization is a viable treatment option when strategies for reperfusion establish both inflow and microcirculatory outflow.
Lang
E V
EV
Department of Radiology, Veterans Administration Medical Center, Palo Alto, CA.
Stevick
C A
CA
D000328:Adult; D000368:Aged; D017130:Angioplasty; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000628:therapy; D002406:Catheterization, Peripheral / Q000295:instrumentation; D003131:Combined Modality Therapy; D005263:Femoral Artery; D005360:Fibula / Q000098:blood supply; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000188:drug therapy / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery; D015642:Radiology, Interventional; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000628:therapy; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014654:Vascular Patency; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator