Assessment of peripheral intraarterial thrombolysis versus surgical revascularization in acute lower-limb ischemia: a review of limb-salvage and mortality statistics.
OBJECTIVE
To review the risks and benefits of using peripheral intraarterial thrombolysis (PIAT) versus surgical revascularization (SR) as the initial treatment of acute lower-limb ischemia (ALLI).


METHODS
Two prospective, randomized trials that compared PIAT with SR in the treatment of ALLI were analyzed along with recent large, retrospective studies. Overall, 1,051 SR cases and 895 PIAT cases were included; when possible, the ischemic events were further categorized as acute, chronic, embolic, or thrombotic. Limb salvage and mortality at 30-day and 6-12-month follow-up were assessed. Combined percentages were derived by proportionally weighing each study.


RESULTS
When all studies were combined, limb salvage rates were 93% for PIAT and 85.5% for SR at 30 days and 89% versus 73%, respectively, at 6-12-month follow-up. Mortalities were 4% versus 15%, respectively, at 30 days and 8% versus 29%, respectively, at 6-12-month follow-up.


CONCLUSIONS
PIAT is associated with a substantially better limb-salvage rate and mortality than SR in the treatment of ALLI.
Diffin
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DC
Brigham and Women's Hospital, Boston, Mass., USA.
Kandarpa
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K
D000208:Acute Disease; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D010960:Plasminogen Activators / Q000627:therapeutic use; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D013300:Streptokinase; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator