title: Safety and Effectiveness of Adjunctive Intra-Arterial Abciximab in the Management of Acute Limb Ischemia.
abstract: BACKGROUND
  Contemporary endovascular management of acute limb ischemia (ALI) generally consists of tissue plasminogen activator (tPA) based catheter-directed thrombolysis (CDT) with or without pharmacomechanical thrombectomy (PMT). Although abciximab (Reopro), a GPIIb/IIIa receptor antagonist, is widely used in coronary revascularization, its safety and effectiveness in the treatment of ALI are unknown. Here, we review our contemporary experience with the endovascular management of ALI and assess the safety and effectiveness of abciximab.
  
  
  METHODS
  A total of 49 consecutive patients with Rutherford class II (RII) ALI undergoing CDT for ALI from 2011 to 2014 was identified. Demographics, procedural details, and outcomes were assessed and are reported.
  
  
  RESULTS
  A total of 44 patients with RII ALI underwent tPA-based CDT in 49 discrete interventions. In 11 patients adjunctive abciximab infusion was also used. The majority (82%) of patients treated with tPA ± PMT required overnight infusion and at least one subsequent procedure. Single-stage (on-table) thrombolysis was achieved in 91% of cases with adjunctive abciximab use versus 18% with tPA alone (P < 0.001). There was significantly less need for intensive care unit (ICU) monitoring, and there were no bleeding complications associated with adjunctive abciximab use. Overall length of stay and total operating room (OR) time favored the abciximab group but did not reach statistical significance. Overall primary patency, secondary patency, and amputation-free survival were 46 ± 9.9%, 79 ± 6.6%, and 78 ± 9.2% at 1 year.
  
  
  CONCLUSIONS
  Early results suggest adjunctive abciximab may safely facilitate on-table thrombolysis for RII ALI. This approach appears to be associated with reduced resource utilization including fewer procedures, shorter OR time, and less ICU admissions. One-year outcomes compare favorably to a similar cohort of ALI patients treated with tPA-based therapy alone.
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY. Electronic address: ggs9002@nyp.org.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Salzler
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
authors.forename: Ashley
authors.initials: A
authors.lastname: Graham
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Connolly
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
authors.forename: Darren B
authors.initials: DB
authors.lastname: Schneider
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Meltzer
mesh_terms: D000077284:Abciximab; D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007261:Infusions, Intra-Arterial; D007511:Ischemia / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab