[Intraarterial thrombolysis in acute limb ischaemia: alternative treatment and basic principles of further interventions].
BACKGROUND
Intraarterial thrombolysis of acute arterial occlusions in the lower limbs is an established therapeutic procedure. However, its value as a primary treatment is discussed controversially and it is mostly seen as a competing procedure to primary vascular surgical interventions.


METHODS
From January 2001 to December 2004, we performed a total of 132 intraarterial thrombolysis procedures in 112 patients with acute or subacute ischaemia of the lower limbs. In the majority of the cases, there was an ischaemia of stage I or II a according to Rutherford, a few further cases were in stage II b at the start of treatment. The patients' ages at the time of thrombolysis was 64.7+/-11.3 years (mean value+/-standard deviation, range: 27-91 years). There were 46 female and 86 male patients.


RESULTS
The average duration of thrombolysis was 35.2+/-20.8 hours (mean+/-standard deviation, range: 6-142 hours). As median 2 (range: 0-8) angiographic controls were performed. In 100 cases (75.8%), an operation could be avoided by thrombolysis alone or in combination with an supplementary intervention. On the other hand, in 32 cases (24.2%) a subsequent operative therapy including 10 major amputations (7.6%) was necessary. Because of hemorrhagic complications, 15 thrombolysis procedures (11.4%) had to be terminated prematurely but only 2 patients required an inguinal revision. Therapy-related mortality was 0.8% (1 patient).


CONCLUSIONS
In the majority of our patients, primary intraarterial thrombolysis was successful and often led to the discovery of the underlying vascular lesion. It can serve both as a therapeutic alternative to a primary vascular surgical intervention and as the foundation further interventional or vascular surgical therapies although this cannot always be predicted for individual cases.
Weinrich
M
M
Klinik für Allgemeine Chirurgie, Viszeral-, Gefäss- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar.
Justinger
C
C
Köhler
M
M
Frech
R
R
Schilling
M
M
Kreissler-Haag
D
D
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D002406:Catheterization, Peripheral; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator