title: Independent factors predicting early lower limb intra-arterial thrombolysis failure.
abstract: BACKGROUND
  Risk factors for early catheter-directed intra-arterial thrombolysis failure in acute lower limb ischemia remain unclear.
  
  
  METHODS
  One hundred forty-nine limbs with acute artery or bypass graft thrombosis underwent catheter-directed thrombolysis (maximum of 48 hours). A retrospective data analysis was carried out to assess possible risk factors for early, 30-day treatment failure.
  
  
  RESULTS
  Seventy-nine men (53%) and 70 women (47%) with a median age of 70 (range 32-93) years were treated. Treatment outcomes were determined as success (N = 115, 77%) or failure (N = 34, 23%). The failure criteria comprised rapid progression of ischemia (N = 4, 2.7%) and major bleeding complications (N = 2, 1.3%), both requiring thrombolysis termination and surgery. Inability to reopen native arteries/grafts (N = 10, 6.7%), run-off vessels (N = 10, 6.7%), in-hospital death (N = 4, 2.7%), the need for major amputation (N = 13, 8.7%), and reocclusions (N = 5, 3.4%) within the 30-day follow-up period were also considered as failures. Multivariate analysis of the risk factors' impact on the success of thrombolysis revealed such independent parameters as hypercholesterolemia (OR 0.16, 95% CI 0.06-0.42, P < 0.0001), previous bypass grafting of the ipsilateral limb (OR 0.18, 95% CI 0.06-0.53, P = 0.002), and duration of ischemia prior to the initiation of thrombolysis (OR 0.95, 95% CI 0.91-0.99, P = 0.009, per day).
  
  
  CONCLUSIONS
  According to our results, factors independently predicting early failure include hypercholesterolemia, previous bypass grafting, and a delay in treatment initiation. Moreover, catheter-directed intra-arterial thrombolysis can be considered safe and effective in the treatment of acute lower limb ischemia.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland. Electronic address: damir@fimnet.fi.
authors.forename: Damir
authors.initials: D
authors.lastname: Vakhitov
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Velipekka
authors.initials: V
authors.lastname: Suominen
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland; Division of Interventional Radiology, Department of Radiology, Tampere University Hospital, Tampere, Finland.
authors.forename: Janne
authors.initials: J
authors.lastname: Korhonen
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Niku
authors.initials: N
authors.lastname: Oksala
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Juha-Pekka
authors.initials: JP
authors.lastname: Salenius
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006470:Hemorrhage / Q000139:chemically induced; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000401:mortality; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D005343:Fibrinolytic Agents