Intra-arterial thrombolysis for the acutely ischaemic leg: experience in a district general hospital.
Intra-arterial thrombolytic therapy (IATT) is a recognized treatment for acute on chronic lower limb ischaemia due to thrombosis when duration of therapy will not compromise limb viability. In this prospective study at a district general hospital, 36 consecutive patients (mean age 73.6 +/- 1.7 years) with acute lower limb ischaemia, presenting as severe and worsening claudication or rest pain, underwent urgent IATT using streptokinase (n = 35) or tPA (n = 1). Thrombolysis was monitored by daily angiography. IATT was performed alone in 26 patients and in conjunction with angioplasty in a further 10 patients. Mean treatment duration was 2.27 + 0.25 days. The 30 day mortality was 11.1% Complications abbreviated IATT in 8.3%. The 30 day primary limb salvage rate for IATT +/- angioplasty was 44.4% (16/36). The mean ABPI pre IATT +/- angioplasty was 0.19 +/- 0.04(n = 35) compared with 0.52 +/- 0.08 after IATT +/- angioplasty (n = 31) (P < 0.011). Eight patients without clinical benefit underwent salvage surgery with a secondary limb salvage rate of 61%. ABPI post-salvage surgery was similarly increased to 0.54 +/- 0.17. Intra-arterial thrombolytic therapy for the acutely ischaemic leg in a district general hospital, may contribute to limb salvage.
Directorate of Scientific Services and Surgery, Wellhouse Trust, Barnet, Herts, UK.
A J
AJ
Marcus
P
P
Bearn
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013300:Streptokinase / Q000627:therapeutic use*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase