title: Initial results of catheter-directed ultrasound-accelerated thrombolysis for thromboembolic obstructions of the aortofemoral arteries: a feasibility study.
abstract: OBJECTIVE
  This article reports the 30-day technical and clinical outcome of ultrasound (US)-accelerated thrombolysis in patients with aortofemoral arterial thromboembolic obstructions.
  
  
  METHODS
  A prospective cohort study was conducted from December 2008 to December 2009 of patients who were treated with US-accelerated thrombolysis for thromboembolic obstructions of aortofemoral arteries or bypasses. Urokinase was infused in a dosage of 100,000 IU per hour. Twice daily, a control angiography was performed. Thirty-day follow-up consisted of duplex scanning, combined with magnetic resonance angiography.
  
  
  RESULTS
  The study included 21 consecutive patients (20 men; median age, 66 (range, 52-80) years) with 24% artery versus 76% bypass occlusions. Median duration of symptoms was 11 (range, 7-140) days. Median occlusion length was 32 (range, 6-80) cm. In 20 patients (95%), an US-accelerated thrombolysis catheter could be successfully placed. In one patient, placement of an US-accelerated thrombolysis catheter was technically not feasible, and therefore a standard catheter was placed. Median thrombolysis time was 26.5 (range, 8.5-72) hours. Complete thrombolysis (>95% lysis of thrombus) was achieved in 20 patients; in 9 patients within 24 hours. Median ankle-brachial index (ABI) increased from 0.28 (range, 0-0.85) to 0.91 (range, 0.58-1.35). One patient had a thromboembolic complication and needed surgical intervention. No hemorrhagic complications, and no deaths occurred. At 30-day follow-up, 17 of 21 patients (81%) had a patent artery or bypass.
  
  
  CONCLUSIONS
  This feasibility study showed a high technical success rate of US-accelerated thrombolysis for aortofemoral arterial obstructions. US-accelerated thrombolysis led to complete lysis within 24 hours in almost half of patients, with a low 30-day major complication rate.
authors.affiliation: Department of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. m.schrijver@antoniusziekenhuis.nl
authors.forename: A Marjolein
authors.initials: AM
authors.lastname: Schrijver
authors.forename: Michel M P J
authors.initials: MM
authors.lastname: Reijnen
authors.forename: Jacques A
authors.initials: JA
authors.lastname: van Oostayen
authors.forename: Arjan W J
authors.initials: AW
authors.lastname: Hoksbergen
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Lely
authors.forename: Marc
authors.initials: M
authors.lastname: van Leersum
authors.forename: Jean-Paul P M
authors.initials: JP
authors.lastname: de Vries
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015331:Cohort Studies; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D013923:Thromboembolism / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D014464:Ultrasonic Therapy / Q000295:instrumentation / Q000379:methods*