title: Catheter-directed thrombolysis-assisted angioplasty for chronic lower limb ischemia.
abstract: BACKGROUND
  Thrombolysis is an appropriate treatment for acute arterial occlusion. There remains controversy as to whether thrombolysis before angioplasty helps to identify the underlying lesion and improve results for chronic ischemia of the lower extremity. We sought to investigate the feasibility of catheter-directed thrombolysis-assisted angioplasty for chronic lower limb ischemia.
  
  
  METHODS
  Between July 2008 and December 2009, the data of patients with chronic lower limb ischemia undergoing catheter-directed thrombolysis-assisted angioplasty were retrospectively analyzed.
  
  
  RESULTS
  Twenty consecutive patients (18 men with a mean age of 56.35 ± 8.5 years) underwent thrombolysis-assisted angioplasty for occlusion of a native artery (n = 18) or bypass graft (n = 2). The median duration of symptoms was 19 months (range: 3-48 months). Symptoms included disabling claudication in 12 patients, rest pain in 5 patients, and gangrene of the toes in 3 patients. Urokinase or recombinant tissue plasminogen activator as a thrombolytic agent was used before angioplasty. The mean length of occlusive lesions decreased significantly from 150 mm to 30 mm after thrombolysis (P < 0.01). Four patients had no change in their lesions. Improvement of Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) classification was achieved in 16 patients, with 14 TASC IIA lesions and 2 TASC IIB lesions after thrombolysis. Subsequent stenting was successfully performed in all patients. The ankle-brachial index increased significantly from 0.33 to 0.63 (P < 0.01). No perioperative deaths occurred. Morbidity included access site bleeding in 1 patient and distal embolization in 2 patients without further intervention. The primary patency rate at 1 year was 95%, with a median follow-up time of 19 months.
  
  
  CONCLUSIONS
  Catheter-directed thrombolysis-assisted angioplasty is a safe and effective treatment in some patients with chronic lower limb ischemia. It may reduce the magnitude of the lesion and simplify the expected intervention procedures.
authors.affiliation: Beijing Shijitan Hospital, Beijing, China. Electronic address: fuxianvascular@yahoo.cn.
authors.forename: Fuxian
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Beijing Shijitan Hospital, Beijing, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Beijing Shijitan Hospital, Beijing, China.
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Luo
authors.affiliation: Beijing Shijitan Hospital, Beijing, China.
authors.forename: Gangzhu
authors.initials: G
authors.lastname: Liang
authors.affiliation: Beijing Shijitan Hospital, Beijing, China.
authors.forename: Yaping
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA.
authors.forename: Wayne Wei
authors.initials: WW
authors.lastname: Zhang
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000295:instrumentation; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices
chemical_list: D005343:Fibrinolytic Agents