title: Thrombolysis as initial treatment of peripheral native artery and bypass graft occlusions in a general community hospital.
abstract: Large series with long-term follow-up of thrombolytic therapy in the treatment of lower limb arterial occlusion from a single, general, non-university hospital are absent. We studied retrospectively the results of 129 consecutive patients who underwent thrombolysis with intraarterial urokinase as initial treatment for lower limb native artery or bypass graft occlusions. The mean age of patients was 71 years; 55% of the patients were male, and preexisting peripheral arterial disease was present in 47%. Presenting symptoms were disabling claudication (31%) and limb-threatening ischemia (69%). Forty-two percent of the patients presented with acute symptoms (<1 week duration). The mean follow-up of patients still alive at the time of analysis was 36 months (range 1-120 months). Thrombolytic treatment was successful in 93 patients (72%). In 53% of the patients acute surgical intervention could be avoided: 28 patients (22%) did not need any additional procedure and 40 (31%) underwent a concomitant angioplasty. When thrombolysis failed, 6 patients (5%) underwent successful surgical revascularization and 11 patients (8%) eventually underwent major amputation during their hospital stay. Amputation-free survival at 6 months and at last follow-up was 88% and 83%, respectively. The mortality rates were 4% at 30 days, 5% at 6 months, and 30% at last follow-up. Thrombolysis was significantly less successful when patients had diabetes (62% vs. 81%, p = 0.019) or preexisting peripheral arterial disease (61% vs. 80%, p= 0.018). Successful radiological treatment (thrombolysis+/-angioplasty) could less often be performed in patients with preexisting peripheral arterial disease (41% vs. 59%, p = 0.011) and in patients with occluded bypass grafts (33% vs. 62%, p= 0.002). Duration of symptoms and Fontaine stage at presentation did not predict thrombolysis outcomes. Thrombolytic-related complications occurred in 17 patients (13%), with significant bleeding from the puncture site in 3 patients (2%). Thrombolysis can safely and effectively be performed in a general community hospital with results comparable to those reported from specialized university centers and large randomized trials.
authors.affiliation: Department of Surgery, St Lucas/Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Stephanie O
authors.initials: SO
authors.lastname: Breukink
authors.forename: Bart C
authors.initials: BC
authors.lastname: Vrouenraets
authors.forename: Gareth A
authors.initials: GA
authors.lastname: Davies
authors.forename: Anthony
authors.initials: A
authors.lastname: Voorwinde
authors.forename: Tietse A
authors.initials: TA
authors.lastname: van Dorp
authors.forename: Rudi M J M
authors.initials: RM
authors.lastname: Butzelaar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006764:Hospitals, Community; D006769:Hospitals, General; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000628:therapy; D035002:Lower Extremity / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000628:therapy*; D010960:Plasminogen Activators / Q000627:therapeutic use*; D012086:Reoperation; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013995:Time; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator