title: Outcomes of intra-arterial thrombolysis for acute limb ischemia.
abstract: Intra-arterial thrombolysis is an alternative treatment to surgery for acute limb ischemia. We report our own experiences by retrospectively assessing initial and long-term outcomes using this strategy. Patients (n = 48; 50 events) underwent thrombolysis according to our protocol (64.6% male, median age 68.5 years). Using thrombolysis as an initial treatment strategy, overall limb survival on index admission was 84%. Of this group who had successful limb salvage, 76% was attributable to thrombolysis alone, and 24% had limb salvage attributable to subsequent surgery after failed thrombolysis or anticoagulation. Significant complications occurred in 8% of cases, and no deaths were attributed to thrombolysis. Patients alive at 6 and 24 months after index admission who had limb salvage attributable to thrombolysis alone had limb survival rates of 89% and 82%, respectively. The majority of these patients had not required subsequent secondary procedures to maintain limb survival. Thrombolysis is an acceptable and less invasive treatment of acute limb ischemia, with many patients not needing subsequent surgery.
authors.affiliation: Department of Vascular Surgery, Queen Elizabeth Hospital, Gateshead, United Kingdom.
authors.forename: S J
authors.initials: SJ
authors.lastname: Amonkar
authors.forename: M
authors.initials: M
authors.lastname: Cleanthis
authors.forename: Colin
authors.initials: C
authors.lastname: Nice
authors.forename: Grace
authors.initials: G
authors.lastname: Timmons
authors.forename: A M
authors.initials: AM
authors.lastname: Mudawi
authors.forename: H Y
authors.initials: HY
authors.lastname: Ashour
authors.forename: V
authors.initials: V
authors.lastname: Bhattacharya
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005121:Extremities / Q000098:blood supply*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator