Value of transesophageal echocardiography, esophago-gastroduodenoscopy and retinoscopy prior to intra-arterial fibrinolytic therapy in patients with peripheral arterial disease.
BACKGROUND
We prospectively investigated the need for esophagogastroduodenoscopy (EGD), transesophageal echocardiography (TEE) and retinoscopy for pre-interventional screening in patients with peripheral arterial occlusive disease (PAD) prior to intraarterial fibrinolytic therapy.


METHODS
212 consecutive patients suffering from PAD (164 male and 48 female, mean age: 64 +/- 11 years, 161 patients stage II of Fontaine's classification, 10 patients at stage III and 41 patients at stage IV) referred for interventional treatment were included. 173 EGDs, 169 TEEs and 188 retinoscopies were performed within one week prior to fibrinolysis. 114 patients had all three examinations.


RESULTS
Pathologic findings were detected in 56 (49%) of the 114 patients: 23 erosions, 12 ulcers, 2 esophagites, 1 gastric carcinomata, 3 intracardiac thrombi, 5 aortic thrombi, 11 diabetic and 5 hypertensive retinopathies and 1 with retinal aneurysms. 30 patients (25%) received fibrinolytic therapy, despite a contraindication: The one patient with ventricular thrombus was treated as an ultimate therapy, and amputation was prevented. Two patients showing plaques covered by large thrombi in the descending thoracic aorta were treated because cranial embolism should not occur. Four diabetic patients with multilevel disease, severe claudication and prior retinal bleeding were treated. Fibrinolytic therapy was started on 23 patients after complete healing of the mucosal lesions.


CONCLUSIONS
TEE revealed potential sources of embolization in 4% of the patients and is justified to reduce the individual risk. Retinoscopy should be done in patients with diabetes mellitus and hypertension, and if prior bleeding is present fibrinolysis should be done only if other treatment-regimes are not available.
Kröger
K
K
Department of Angiology, University Hospital, Essen, Germany. knut.kroeger@uni-essen.de
Biro
F
F
Zeeh
J M
JM
Bartel
Th
T
Vij
O
O
Goyen
M
M
Ruehm
St G
SG
Santosa
F
F
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000188:drug therapy*; D000075202:Contraindications; D017548:Echocardiography, Transesophageal; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D012160:Retina / Q000187:drug effects; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects