Success of thrombolysis as a predictor of outcome in acute thrombosis of popliteal aneurysms.
OBJECTIVE
Acute limb ischemia after thrombosis of a popliteal aneurysm is a distinct and limb-threatening entity. Preoperative intra-arterial thrombolysis may improve the outcome in this challenging situation. This study retrospectively analyzed a consecutive series of patients treated with preoperative thrombolysis and subsequent revascularization.


METHODS
Thirteen patients with acute limb ischemia caused by thrombosis of a popliteal aneurysm underwent catheter-directed intra-arterial thrombolysis with urokinase and subsequent vascular reconstruction. The angiographic and clinical outcome was analyzed and compared with that in the literature.


RESULTS
Complete aneurysm thrombosis with absence of runoff was documented in 12 cases. Thrombolysis restored perfusion with patency of the popliteal artery and a one- or two-vessel runoff in 77% of cases (10/13). Early cumulative graft patency and limb salvage rates were 68% and 83%, respectively, with an ankle/brachial index of 0.8 +/- 0.2. Lytic failure followed by attempts at bypass grafting was present in three patients (23%) and resulted in above-knee amputation. Severe rhabdomyolysis and fatal pulmonary embolism were responsible for a 15% early mortality rate.


CONCLUSIONS
Preoperative thrombolysis followed by bypass grafting is a valid treatment option for patients who can withstand an additional period of ischemia that does not require immediate revascularization and intraoperative lysis. Lytic failure identifies patients with a highly compromised runoff who are probably best treated by means of subsequent amputation, without any attempts at bypass grafting.
Marty
Bettina
B
Department of Cardiovascular Surgery, University Hospital of Lausanne, Switzerland.
Wicky
Stephan
S
Ris
Hans-Beat
HB
Mueller
Xavier
X
Fischer
Adam
A
Hayoz
Daniel
D
von Segesser
Ludwig Karl
LK
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000150:complications* / Q000188:drug therapy*; D005121:Extremities / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013927:Thrombosis / Q000150:complications* / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D014654:Vascular Patency / Q000187:drug effects
D014568:Urokinase-Type Plasminogen Activator