title: Outcome after thrombolysis for occluded endoprosthesis, bypasses and native arteries in patients with lower limb ischemia.
abstract: BACKGROUND
  To report contemporary outcomes, and evaluate differences after thrombolysis for occluded endoprosthesis, bypasses and native artery occlusion in patients with lower limb ischemia.
  
  
  METHODS
  Patients undergoing local intra-arterial thrombolysis for lower limb ischemia between 2001 and 2010 were identified in the prospective database for endovascular intervention, and analysis was performed retrospectively.
  
  
  RESULTS
  There was an increase in thrombolysis for occluded endoprosthesis and a decrease in thrombolysis for occluded bypasses during the study period (p=0.001). The technical success rate for thrombolysis in occluded endoprosthesis, bypasses and native artery occlusion was 91%, 89% and 73%, respectively. The overall major amputation rate, mortality rate and amputation-free survival rate at 1 year was 19%, 14% and 73%, respectively, without differences between groups. The major amputation rate at long-term was highest, 45%, for patients with occluded synthetic bypass grafts. Female gender (HR 1.7; 95% CI 1.1-2.7), ischemic heart disease (HR 1.8; 95% CI 1.1-2.8), anemia at admission (HR 1.9; 95% CI 1.2-3.0), foot ulcer (HR 4.4; 95% CI 2.4-8.0), motor deficit at admission (HR 2.5; 95% CI 1.4-4.3), occluded synthetic bypass graft (HR 3.3; 95% CI 1.9-5.7) and failure of thrombolysis (HR 4.8; 95% CI 2.9-7.7) were independently associated with an increased long-term risk of major amputation.
  
  
  CONCLUSIONS
  Thrombolysis for occluded endoprosthesis, bypasses and native artery occlusion was effective. Female gender, ischemic heart disease, anemia, foot ulcer, motor deficit, occluded synthetic bypass graft and failure of thrombolysis were independently associated with an increased risk of major amputation.
authors.affiliation: Vascular Center, Malmö University Hospital, Malmö, Sweden.
authors.forename: Monica
authors.initials: M
authors.lastname: Kuoppala
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Malmö University Hospital, Malmö, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Åkeson
authors.affiliation: Vascular Center, Malmö University Hospital, Malmö, Sweden. Electronic address: Stefan.acosta@telia.com.
authors.forename: Stefan
authors.initials: S
authors.lastname: Acosta
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Bypass; Endoprosthesis; Lower limb ischemia; Major amputation; Mortality; Stentgrafts; Stents; Thrombolysis