title: Percutaneous transluminal angioplasty combined with intra-arterial thrombolysis to treat lower-extremity arterial occlusion in thromboangitis.
abstract: BACKGROUND
  The aim of this paper was to evaluate the efficacy of percutaneous transluminal angioplasty and the intra-arterial infusion of thrombolytic drugs in the treatment of lower extremity (LE) arterial occlusion during thromboangiitis obliterans (TO).
  
  
  METHODS
  Between February 2008 and October 2013, 13 consecutive patients with TO and LE arterial occlusion underwent 18 sessions of PTA. One LE was affected in 11 patients and both LEs in two patients. An antegrade approach with transfemoral access was used in 17 procedures, and a retrograde approach via the contralateral common femoral artery (CFA) in one procedure. Under fluoroscopic guidance, a 260 cm wire (0.014 inch diameter), with a stiff body and a soft tip, was passed through the occlusion, followed by a 2.5-4 mm deep balloon, and the occlusions were dilated. After dilation, the deep balloon was removed and the straight tip of a thrombolysis catheter inserted, through which to intra-arterially infuse the thrombolytic drug.
  
  
  RESULTS
  Percutaneous transluminal angioplasty (PTA) was successful in 39 of the 61 LE occluded arteries, so the technical success was 63.9%. No mortality or serious complication related to PTA was observed. There were significant differences between The Ankle Brachial Index (ABI) at the time of admission (1st-ABI), immediately after the first PTA (2nd-ABI), and at the time of patient discharge (3rd-ABI) (P=0.000). The self-reported maximum walking distance (SRMWD) before and after PTA were also significantly different (P=0.000). All the patients were followed-up for a mean period of 28.4±11.2 months (13-46 months).
  
  
  CONCLUSIONS
  PTA using a deep balloon combined with the intra-arterial infusion of thrombolytic drugs is an effective and safe treatment for TO in patients to recanalize the occluded LE vessels.
authors.affiliation: Department of Interventional Radiology, First Hospital of Lanzhou University, Lanzhou, Gansu, China - robterli@126.com.
authors.forename: Fen Q
authors.initials: FQ
authors.lastname: Li
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Xue W
authors.initials: XW
authors.lastname: He
authors.forename: Mao X
authors.initials: MX
authors.lastname: Zhang
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wang
mesh_terms: D000328:Adult; D017130:Angioplasty / Q000009:adverse effects; D055109:Ankle Brachial Index; D003131:Combined Modality Therapy; D005080:Exercise Test; D017079:Exercise Tolerance; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007261:Infusions, Intra-Arterial; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D020127:Recovery of Function; D012189:Retrospective Studies; D013919:Thromboangiitis Obliterans / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D016138:Walking
chemical_list: D005343:Fibrinolytic Agents