Catheter-directed thrombolysis in thrombotic acute lower limb ischemia: challenges and management

Abstract

Background The aim of this study to assess the result of catheter directed thrombolysis (CDT) in acute thrombotic lower limb ischemia with special emphasis on the technique and challenges. Methods It is a prospective study that was held in vascular surgery department, Cairo University from March 2016 to March 2018. Twenty four patients with ALI were recruited with infra-inguinal acute native arterial occlusions less than 14 days. Inclusions criteria were age is less than 75 years, ALI categories I, IIa Rutherford classification. Exclusion criteria were; acute embolic ischemia, ALI category IIb or III Rutherford classification, occluded bypass graft, contraindication of thrombolytic therapy and Patients older than 75 years. Result Twenty four consecutive patients (19 males and 5 females) were included in the study with mean Age 63.5 years. Out of 24 CDTs performed, 20 patients (83.3%) required additional procedures, 15 percutaneous intervention (12 balloon dilatations and 6 stentings for superficial femoral artery (SFA), and 3 cases of aspiration thrombectomy) and 3 open procedures (3 cases of popliteal thromboemolectomy) and 2 hybrid cases of CFA thromboendarterectomy and angioplasty for femeropoliteal segment). Five bleeding complications were reported in the study group with 4 clinically non- major bleeding complications, all were managed conservatively. Major bleeding from groin required surgical intervention in only one case. A total of 4 (16.6%) major amputations were done during the follow-up period, the amputation-free survival was 87.5%, 83.3%, and 83.3 at one, three, and six months post-procedurally. No mortalities in the study patients during 6 months of follow up. Conclusion Thrombolytic therapy remains an effective and valuable option for treatment of ALI. About 25% of patients still required an open procedure post thrombolytic therapy. So; proper patients selection is needed to detect patient who will benefit from primary surgery rather than thrombolysis.