title: Outcomes of accelerated catheter-directed thrombolysis in patients with acute arterial thrombosis.
abstract: Current intra-arterial catheter-directed thrombolysis (CDT) protocols recommend treatment with small doses of a thrombolytic agent, which excludes patients in need of urgent revascularization. We evaluated the effects of accelerated thrombolysis utilizing increased recombinant tissue plasminogen activator (rt-PA) doses. Forty-one patients with acute, thrombotic limb ischemia (ALI) were treated using accelerated CDT. The treatment consisted of an initial dose of 10 mg rt-PA for 30 minutes followed by a 3-hour course of a continuous intra-arterial 10 mg/hour rt-PA infusion. Simultaneously, intravenous unfractionated heparin (500 IU/hour) was administered. No deaths occurred. Satisfactory lysis was achieved in 37 of the 41 patients (90.2%). All significant underlying lesions were corrected (89.2%). Complications developed in nine patients (22%); the most frequent complication (four patients, 9.8%) was puncture site hematoma. The reintervention rate was 2.6% and 15.4% at the 1 and 6-month follow-ups, respectively. The major amputation rate was 10.3% and 12.8% at the 1 and 6-month follow-ups, respectively. Outflow compromise was adversely related to successful outcome at the 6-month follow-up (p=0.01). In conclusion, this study confirms the effectiveness and safety of the accelerated CDT regimen for treatment of thrombotic ALI at a single center, but requires confirmation in further studies.
authors.affiliation: Department of Vascular Surgery, Regional Specialty Hospital, Grudziadz, Poland alukasiewicz@wp.pl.|Department of Tissue Engineering, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Lukasiewicz
authors.affiliation: Department of Vascular Surgery, Regional Specialty Hospital, Grudziadz, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Lichota
authors.affiliation: Department of Vascular Surgery, Regional Specialty Hospital, Grudziadz, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Thews
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D002406:Catheterization, Peripheral / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007261:Infusions, Intra-Arterial; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011044:Poland; D011446:Prospective Studies; D011677:Punctures; D011994:Recombinant Proteins / Q000008:administration & dosage; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: accelerated thrombolysis; acute limb ischema; peripheral artery disease; revascularization; thrombolytic therapy; thrombosis