When is thrombolysis for acute lower limb ischemia worthwhile?
OBJECTIVE
To find variables associated with outcome following thrombolytic treatment for acute lower limb ischemia.


METHODS
Re-analysis of a prospective multicentre study.


METHODS
One hundred and twenty-one patients with acute lower limb ischemia previously included in a randomised study comparing high- with low-dose thrombolysis were re-analysed ignoring the mode of lytic treatment. All possibly predictive variables were subjected to multivariate analyses to find associations with outcome.


RESULTS
Previous successful thrombolysis, ankle-brachial index over 0.33, absence of motor dysfunction, presence of cardiac arrhythmia, and lysis of a vascular graft were all associated with successful thrombolysis (p=0.003). Previous thrombolysis, age less than 70 years, and ankle-brachial index over 0.33 were all perfect predictors of absence of life-threatening complications or death. Successful lysis, age<70, and lysis of a native artery as opposed to a vascular graft were all associated with clinical success (preserved patency, limb, and life) after one year (p=0.002).


CONCLUSIONS
Previous thrombolysis, age under 70 years, and non-severe ischemia predict successful thrombolysis free from severe complications. Successful thrombolysis is strongly predictive of amputation-free survival with vascular patency for at least one year. Occluded grafts could often be reopened, but long-term outcome is better after thrombolysis of native arteries.
Plate
G
G
Department of Surgery, Central Hospital, Helsingborg, Sweden. gunnar.plate@skane.se
Oredsson
S
S
Lanke
J
J
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000842:Ankle / Q000098:blood supply; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013548:Sweden; D015912:Thrombolytic Therapy / Q000009:adverse effects; D017211:Treatment Failure; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures