title: Do randomized trials of thrombolysis versus open revascularization still apply to current management: what has changed?
abstract: Several randomized trials of catheter-directed thrombolysis versus operative revascularization in patients with acute lower extremity ischemia were performed in the mid-1990 s. Although the outcomes of these trials were not definitive, they did provide insight into potential uses and techniques of catheter-directed thrombolysis and lytic agents. This article reviews the outcomes of these randomized trials and describes advances in thrombolytic techniques and technology, including percutaneous mechanical thrombectomy devices and innovative catheter designs that accelerate lysis and the development of direct-acting lytic agents.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Comerota
authors.forename: Marilyn H
authors.initials: MH
authors.lastname: Gravett
mesh_terms: D000208:Acute Disease; D000671:Amputation, Surgical; D003131:Combined Modality Therapy; D004867:Equipment Design; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents