title: Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia.
abstract: OBJECTIVE
  The purpose was to study long-term outcome after thrombolysis for acute arterial lower limb ischaemia, and to evaluate the results depending on the underlying aetiology of arterial occlusion.
  
  
  METHODS
  This was a retrospective study of patients entered into a prospective database. Patients were identified in prospective databases from two vascular centres, including a large number of variables. Case records were analysed retrospectively. Through cross linkage with the Population Registry 100% accurate survival data were obtained. Between January 2001 and December 2013, 689 procedures were included. The aetiology of ischaemia was graft/stent/stent graft occlusion in 39.8%, arterial thrombosis in 27.7%, embolus in 25.1% and popliteal aneurysm in 7.4%.
  
  
  RESULTS
  The mean follow-up was 59.4 months (95% CI, 56.1-62.7), during which 32.9% needed further re-interventions, 16.4% underwent amputation without re-intervention, and 50.7% had no re-intervention. The need for re-intervention during follow-up was 48.0% in the graft/stent occlusions group, 34.0% of the popliteal aneurysm group, 25.4% in the thrombosis group, and 16.3% in the embolus group (p < .001). The overall primary patency rates were 69.1% and 55.9% at 1 and 5 years, respectively. Primary patency at 5 years was higher for the embolus group (83.3%, p = .002) and lower for the occluded graft/stent group (43.3%, p < .001). Secondary patency rates were 80.1% and 75.2% at 1 and 5 years, respectively, without difference between the subgroups. The amputation rate was lower in the embolic group at 1 and 5 years (8.1% and 11.1%, respectively, p = .001). Survival was higher in the group with occluded popliteal aneurysms at 5 years (83.3%, p = 0.004). Amputation free survival was 72.1% and 45.2% at 1 and 5 years; lower in the occluded graft/stent group at five years (37.9%, p = .007).
  
  
  CONCLUSIONS
  Intra-arterial thrombolytic therapy achieves good medium and long-term clinical outcome, reducing the need of open surgical treatment in most patients.
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: olivia.grip@surgsci.uu.se.
authors.forename: O
authors.initials: O
authors.lastname: Grip
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wanhainen
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Acosta
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Björck
mesh_terms: D000368:Aged; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D016208:Databases, Factual; D004617:Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D013548:Sweden; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute limb ischaemia; Aetiological subgroups; Amputation free survival; Long-term follow-up; Long-term outcome; Thrombolysis