title: Outcome after preoperative or intraoperative use of intra-arterial urokinase thrombolysis for acute popliteal artery thrombosis and leg ischemia.
abstract: OBJECTIVE
  To evaluate the outcome of acute popliteal artery aneurysm (PAA) thrombosis and leg ischemia after preoperative or intraoperative use of intra-arterial urokinase thrombolysis.
  
  
  METHODS
  From 2000 to 2009, 86 patients with acute leg ischemia (Rutherford grade IB to IIA) from PAA thrombosis were treated by immediate surgery including intraoperative thrombolysis (group A: 47 cases) or preoperative thrombolysis (group B: 39 cases) followed by acute (<24 hours) or elective surgery. Chi-square tests for categorical data and time to event provided two-sided p values with a level of significance at 0.05 and all confidence intervals (CIs) at the 95% level.
  
  
  RESULTS
  The mean follow-up was 45 months. The 2-year primary patency was 61.7% (29/47) for group A and 43.6% (17/39) for group B (hazard ratio [HR] 1.85; 95% CI: 0.96 to 3.54; p = 0.06). The 2-year secondary patency was 70.2% (33/47) for group A and 53% (21/39) for group B (HR 1.86; 95% CI: 0.91 to 3.81; p = 0.08). One-month amputation rate was 18% in group A and 29% in group B (p < 0.001), and 12-month amputation rate was 19% (9/47) in group A and 44% (17/39) in B (p = 0.05). In group A, 28% of patients required fasciotomy and in group B, 59% (p < 0.05). Effective thrombolysis allowed 82% limb salvage patency in group B. No systemic or locoregional complications during thrombolysis were recorded, but four cases of worsening ischemia were recorded.
  
  
  CONCLUSIONS
  Our results suggest that the immediate surgery with intraoperative thrombolysis improved the outcome of patients with acute leg ischemia due to PAA thrombosis in terms of limb salvage.
authors.affiliation: Department of Vascular Surgery, Policlinico Casilino, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gabrielli
authors.affiliation: Department of Vascular Surgery, Policlinico Casilino, Rome, Italy.
authors.forename: Maria Sofia
authors.initials: MS
authors.lastname: Rosati
authors.affiliation: Department of Vascular Surgery, Policlinico Casilino, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Carra
authors.affiliation: Department of Vascular Surgery, Policlinico Casilino, Rome, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Vitale
authors.affiliation: Department of Vascular Surgery, Policlinico Casilino, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Siani
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000783:Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007261:Infusions, Intra-Arterial; D007430:Intraoperative Care; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000503:physiopathology; D011300:Preoperative Care; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D014654:Vascular Patency
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator