title: Intraarterial recombinant tissue plasminogen activator thrombolysis of acute and semiacute lower limb arterial occlusion: quality assurance, complication management, and 12-month follow-up reinterventions.
abstract: OBJECTIVE
  The purpose of this study is to assess the efficacy of intraarterial thrombolysis in acute and semiacute occlusions of the lower limb.
  
  
  METHODS
  A total of 77 native arteries and 52 bypass grafts were investigated in 129 patients (mean [± SD] age, 64.6 ± 11.1 years) with acute (i.e., symptoms for ≤ 14 days) or semiacute (i.e., symptoms for > 14 days) peripheral arterial occlusions of the lower limb treated by catheter-directed recombinant tissue plasminogen activator (rt-PA) thrombolysis. Therapeutic success was retrospectively analyzed according to vessel type and duration of occlusion. Morbidity and mortality rates associated with thrombolytic treatment were calculated. The hospitalization period after primary intervention was recorded. Reinterventions and amputations were assessed at 12-month follow-up.
  
  
  RESULTS
  Recanalization was accomplished by rt-PA thrombolysis in 73.6% of all cases. There was no difference in primary therapeutic success between native arteries and bypass grafts (p = 0.601). Thrombolysis was more effective in acute peripheral occlusions, and hospital stays were shorter than those for patients with semiacute occlusion (p = 0.001). The morbidity rate was 31% (minor complications, 20.2%; major complications, 10.9%), and the mortality rate was 2.3%. Within 12 months, radiologic and surgical interventions were necessary for 27 patients. The limb salvage rate after primarily successful recanalization was 89.5%.
  
  
  CONCLUSIONS
  Intraarterial rt-PA thrombolysis is an effective and reasonable method for treating acute peripheral arterial occlusion. The method is less effective in semiacute occlusions, leading to extended hospitalization. Within 12 months, a quarter of the patients required reinterventions, and amputations were necessary in 10% of the cases.
authors.affiliation: Department of Diagnostic Radiology and Neuroradiology, Ernst Moritz Arndt University, Greifswald, Germany. kuehn@uni-greifswald.de
authors.forename: Jens-Peter
authors.initials: JP
authors.lastname: Kühn
authors.forename: Andreas
authors.initials: A
authors.lastname: Hoene
authors.forename: Martin
authors.initials: M
authors.lastname: Miertsch
authors.forename: Tobias
authors.initials: T
authors.lastname: Traeger
authors.forename: Soenke
authors.initials: S
authors.lastname: Langner
authors.forename: Norbert
authors.initials: N
authors.lastname: Hosten
authors.forename: Ralf
authors.initials: R
authors.lastname: Puls
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002406:Catheterization, Peripheral; D015331:Cohort Studies; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial; D035002:Lower Extremity; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator