Can intraoperative thrombolytic therapy assist with the management of acute limb ischemia?
Catheter-directed thrombolytic therapy is a well-accepted treatment modality for acute arterial and graft occlusion, but intraoperative use of plasminogen activators as an adjunct to operative thrombectomy or thromboembolectomy is frequently overlooked by vascular surgeons. Evidence exists that intraoperative intraarterial infusion of lytic agents is safe and is accompanied by breakdown of distal thrombus. This article describes the rationale for intraoperative thrombolysis, reviews the evidence supporting its use, and suggests several technical approaches to incorporating lytic therapy intraoperatively.
Comerota
Anthony J
AJ
Jobst Vascular Center, The Toledo Hospital, Toledo, OH 43606, USA. marilyn.gravett@promedica.org
Sidhu
Ramandeep
R
D000208:Acute Disease; D002404:Catheterization; D003131:Combined Modality Therapy; D017128:Embolectomy; D005121:Extremities / Q000098:blood supply*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007430:Intraoperative Care; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011859:Radiography; D018570:Risk Assessment; D017131:Thrombectomy / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome
D005343:Fibrinolytic Agents