Successful intra-arterial alteplase infusion is a predictor of 12-month limb survival in patients with lower limb arterial occlusion.
OBJECTIVE
To determine the factors predicting amputation of the affected lower limb 12 months after thrombolysis for acute arterial occlusion.


METHODS
The clinical endpoints of 39 patients (24 men, 15 women; average age 69 years) 1 year after catheter-directed thrombolysis with alteplase (mean dose 30 mg, mean duration 24h) for lower limb arterial occlusion (30 native arteries, nine grafts) from January 2001 to June 2005 were assessed. The amputation rate at 12 months was analysed in relation to the thrombolytic outcome, type of vessel occluded, presence or absence of complications, and subsequent requirement for additional surgery on an elective basis using Fischer's exact test.


RESULTS
Successful thrombolysis, defined as complete clot dissolution based on angiographic imaging, was achieved in 64.1% of cases (19 native artery, six bypass graft) with a total complication rate of 23% (n=9). The incidence of major haemorrhage was 7.5% (n=3, hypotension and haematemesis, groin haematoma and hypotension, haematemesis). No patient had an intracranial bleed. One year after thrombolysis, 28.2% (n=11) had further surgery (bypass graft, fasciotomy, embolectomy) and the amputation rate was 20.5% (n=8). Statistical analysis showed that the amputation rate was significantly higher for patients with failed compared with successful thrombolysis (p=0.02). The amputation rates did not reach statistical significance in relation to native artery or graft occlusion, presence or absence of complications, and whether or not additional surgery was required.


CONCLUSIONS
Successful thrombolysis was a predictor for limb survival up to 12 months post-thrombolysis regardless of the type of vessel occlusion, presence of complications or additional surgical requirement.
Disini
L
L
Interventional Radiology, Norfolk and Norwich University Hospital, Norfolk, UK. luisa.disini@nnuh.nhs.uk
Wilson
P
P
Cockburn
J F
JF
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator