Treatment Of Acute Arterial Occlusion Research Articles

Successful Systemic Heparinization for Treatment of Acute Arterial Occlusion of Tibial Artery and Aortic Mural Thrombi in a Patient With COVID-19 Infection: A Case Report

The present case report described a 60-year-old woman who developed multiple isolated acute arterial occlusions of the left anterior tibial artery, peroneal artery, and posterior tibial artery with aortic mural thrombi in the infrarenal aorta during treatment of COVID-19 pneumonia. The patient underwent conservative treatment by systemic heparinization and switched to low molecular weight heparin. She experienced clinical improvement within hours of medical treatment and complete resolution of the tibial artery thrombosis after two weeks of treatment. The aortic mural thrombi was evaluated by computed tomography angiography (CTA) abdomen and lower extremities and resolved after six weeks of anticoagulant administration. Keywords: Acute limb ischemia; Aortic mural thrombi; Thrombosis; COVID-19

Special Considerations in the Diagnosis and Treatment of Acute Arterial Occlusion Caused by Tumor Embolization

Tumor embolism differs from other forms of thromboembolism with special considerations for diagnosis and treatment. This report summarises what we know about this unique pathological process and outlines an approach to surgical treatment. With the advent of new endovascular technologies, there may be several different options available for patients and each individual case needs to be carefully considered given there are no formal guidelines advising the best way to manage this distinct subset of patients.

Recanalization of Acute and Subacute Venous and Synthetic Bypass-Graft Occlusions With a Mechanical Rotational Catheter

Percutaneous mechanical thrombectomy (PMT) is now established as an alternative treatment of acute arterial occlusions in addition to fibrinolysis and surgical thrombectomy. The objective of this retrospective study was the investigation of a rotational atherothrombectomy catheter in terms of safety and efficacy in the treatment of acute and subacute femoropopliteal bypass occlusions. Forty-two patients (average age 65.8 ± 9.1 years) with acute (<14 days [n = 31]) and subacute (14-42 days [n = 11]) femoropopliteal bypass occlusions were treated consecutively with a rotational debulking and removal catheter (Straub Rotarex). The average occlusion length was 28.4 ± 2.9 (24-34) cm. Thirty-four (81%) patients underwent venous bypass, and 8 (19%) patients underwent polytetrafluoroethylene bypass. The technical success rate was 97.6% (41 of 42). In 1 patient, blood flow could not be restored despite the use of the atherothrombectomy system. The average catheter intervention time was 6.9 ± 2.1 (4-9) min. Ankle-brachial index increased from 0.39 ± 0.13 to 0.83 ± 0.11 at discharge and to 0.82 ± 0.17 after 1 month (p < 0.05). There were a total of 2 (4.8%) peri-interventional complications: One patient developed a distal embolism, which was successfully treated with local lysis, and another patient had a small perforation at the distal anastomosis, which was successfully treated with a stent. PMT with the Rotarex atherothrombectomy catheter represents a safe and effective option in the treatment of acute and subacute femoropopliteal bypass occlusions because it can quickly restore blood flow.

The comparison of operative and non-operative treatment for acute embolism of upper extremity artery

To compare surgical and non-surgical therapy of the upper extremity after acute arterial occlusion. To analyze the relation between prognosis and relevant factors of different therapeutic methods. Sixty patients with acute upper extremity arterial embolism treated between January 1990 and October 2007 were retrospectively studied in The First Hospital of China Medical University. There were 60 patients, 32 men and 28 women, with a mean age of 63 years (21 - 86 years). Among them, 31 underwent thrombembolectomies with the Fogarty catheter and 29 received anti-coagulation and thrombolytic therapy. Therapeutic effects were evaluated by Cooley's standard. Therapeutic efficacy was better in the surgical group than in the non-surgical group (P < 0.05). There was no relationship between post-operative ischemic recovery and pre-operative ischemia severity and the site of embolism in the surgical group, while there were significant relationships in the nonsurgical group. The result of Cox proportional hazard regression model showed that the age and Cooley's standard of the patient was correlated with survival time. A more active surgical approach is better for the treatment of acute arterial occlusion of the upper extremity.

Safety and Efficacy of Reteplase for the Treatment of Acute Arterial Occlusion: Complexity of Underlying Lesion Predicts Outcome

We evaluated both the safety and efficacy of reteplase for treatment of acute arterial occlusion as well as outcomes based on treatment of the underlying lesion. From November 2000 to February 2004, reteplase was used to treat arterial occlusions in 81 patients. Catheter-directed intrathrombus thrombolysis was performed with reteplase (0.5 units/hr) continuous infusion. Percutaneous mechanical thrombectomy (Angiojet) was performed in 61% (n = 50) of patients prior to thrombolysis. Unmasking of significant lesions resulted in endovascular intervention (39.5%), open surgical repair (24.6%), or both endovascular and surgical repair (9.8%) of the lesion. No lesion was found in 25.9% of patients. Major and minor complication rates as well as restoration of patency, limb salvage, and amputation-free survival were evaluated. Eighty-one patients received reteplase therapy (median = 10.3 +/- 5.3 units, 19.5 +/- 7.4 hr) followed by next-day arteriogram to assess thrombus removal. Technical success was achieved in 96.2% (n = 78) of cases. Kaplan-Meier life table analysis revealed overall primary patency rates of 76.3%, 60.1%, and 51.6%, at 1, 6, and 12 months, respectively. Overall amputation-free survival rates were 86.4%, 76.4%, and 69.7% at 1, 6, and 12 months, respectively. When subdivided into postlysis intervention, the lysis-only group achieved increased patency (p = 0.0143) and increased limb salvage (p = 0.0219) at 1 year compared to the lysis and endovascular intervention and the lysis and surgical groups. The 30-day complication rate was 17.3% (n = 14), with a major complication rate of 4.9% (n = 4) and a minor complication rate of 12.3% (n = 10). There were no intracranial hemorrhagic complications. Intra-arterial catheter-directed infusion of reteplase for acute lower extremity ischemia is safe and efficacious, as shown by the low risk of bleeding complications, high limb salvage rates, and low mortality rates in this study. The complexity of the lesion that is unmasked through thrombolytic therapy is a predictor of patency and limb salvage.

Thrombolyse des artériopathies des membres

Thrombolytic therapy has been employed for 40 years, by systemic infusion, in the treatment of acute artery occlusions, and since 1971 by local infusion. Several randomised studies published during the 1990's have compared thrombolysis to surgery; they showed the benefits of the thrombolytic therapy, together with, however, the risks and potential complications. The use of thrombolysis combined with endovascular treatment of arterial lesions by recanalisation, thrombo-aspiration, angioplasty with or without endoprosthesis, has allowed defining new therapeutic strategies. The aim of the present chapter is to update one of our previous works by the identification of those new treatment modalities that have been used during the last decade, the presentation of the mechanism of action of standard thrombolytic drugs, streptokinase (SK) and urokinase (UK) utilised by systemic infusion, local fusion, and during per-operative procedures, and finally modern thrombolytic treatments from the plasminogen activator (tPA) to the staphylokinase. A European consensus has allowed to precise indications, contraindications and complications of such treatment (TASC). Recommendation # 59 concludes that there is no more indication for the systemic treatment of acute arterial occlusions with currently available thrombolytic drugs. The contraindications published in 1998 are actually widely known. Current indication remains local thrombolysis. The procedure duration, in addition to the associate risk of complications, is not always compatible with the emergency pattern of the revascularisation necessitated by some acute ischemias. Intra operative treatment is useful in by-pass occlusions. Despite insufficient published data, the combination of surgery and thrombolysis allows reducing both the dose and the duration of the procedure, which can be very important in severe cases of acute ischemia.

An Investigation of the Physical Forces Leading to Thrombosis Disruption by Cavitation

Ultrasound therapy has proven to be an efficient and safe modality for the treatment of acute arterial occlusions, and the use of therapeutic ultrasound for the treatment of thrombosis and vascular diseases holds great promise in overcoming the limitations of other available therapies. Still, there exists little published work that covers the different phenomena that take place in a thorough and comprehensive way. In this paper, we endeavor to address the subject by reviewing work on the physical properties of ultrasound propagation in the blood arteries as it relates to the cavitation of microbubbles, and we compare the impact of the different forces at work for clot disruption. Our conclusion is that the most important effect of ultrasound in the treatment of thrombotic disorders is the liquid-jet impact forces that result from strong bubble collapses in the vicinity of solid boundaries.

Techniques for the percutaneous treatment of acute arterial occlusion.

There are many modalities utilized in the treatment of acute arterial occlusions. The purpose of this report will be to review the various studies defining percutaneous chemical thrombolysis, mechanical thrombectomy, and combination therapies. A clinical paradigm for acute limb ischemia will be defined, and a detailed description of techniques utilized in the above percutaneous interventions will be outlined.

Thrombolytic therapy for arterial thrombosis.

The major development in the field of intra-arterial thrombolytic therapy over the past year was the publication of the phase II results of the Thrombolysis or Peripheral Arterial Surgery study, which compared the safety and efficacy of catheter-directed thrombolysis and surgery as the initial treatment of acute arterial occlusion. The results are consistent with those of the prior two studies, showing little or no difference between surgery and thrombolysis in the most important endpoints of survival and amputation rate. Patients receiving thrombolysis needed fewer interventions, but this benefit was balanced by increased bleeding complications. Additional studies have, therefore, been aimed at identifying subsets of patients with acute arterial occlusion who are most likely to benefit from thrombolysis. These studies have refined the selection criteria for use of thrombolytic therapy over the past year. In addition, studies have been published evaluating new drug doses and regimens aimed at broadening the scope of thrombolytic therapy in patients with acute arterial occlusion.

Gene therapy for arterial thrombosis.

Conventional antithrombotic treatments with antiplatelet, anticoagulant or fibrinolytic drugs are not uniformly successful and are associated with hemorrhagic side effects. Thus, new approaches to the prevention and treatment of arterial thrombosis are desirable. The gene transfer approach is particularly attractive because of its unique ability to express an antithrombotic gene at selected sites of the vessel wall (where thrombosis is threatened) while avoiding systemic anticoagulation. Clinical conditions potentially amenable to antithrombotic gene therapy include coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, peripheral artery angioplasty or thrombectomy, intravascular stenting, and vascular graft prostheses. Gene therapy may prove effective in preventing subacute thrombosis in these settings and, eventually, may play an adjuvant role to systemic thrombolysis in the treatment of acute arterial occlusion. The introduction of an antithrombotic gene into the arterial wall can be achieved either by direct in vivo gene transfer (e.g., by luminal administration of a viral vector) or by in vitro genetic manipulation of cells before their seeding onto vascular grafts, stents, or denuded arteries. The direct gene transfer approach has been used to deliver antithrombotic genes to animal arteries in vivo. Antithrombotic genes used to date include those encoding enzymes of the prostacyclin synthetic pathway, nitric oxide synthase, the thrombin inhibitor hirudin, and thrombomodulin. The in vitro gene transfer approach has been used to enhance the fibrinolytic activity of vascular grafts by overexpressing plasminogen activators. If the initial successes of gene therapy for thrombotic disease in animal models are confirmed by longer-term experiments, and if new vectors are developed which permit prolonged transgene expression without inflammation, human studies can be initiated.

Use of thrombolytic drugs in non-coronary disorders.

Clinical experience with thrombolytics in non-coronary disorders is limited to the plasminogen activators streptokinase, urokinase and alteplase; therapeutic trials with anistreplase (APSAC) are almost, and with saruplase completely, limited to acute myocardial infarction. In terms of thrombus clearance, thrombolytic drugs are superior to heparin in patients with recent deep vein thrombosis in the pelvis or lower limbs. In aggregate, thrombi younger than 8 days are lysed in approximately 60% of patients treated with streptokinase, urokinase or alteplase. The results of studies assessing the subsequent development of the postphlebitic syndrome are conflicting, but most suggest that thrombolytic therapy can reduce symptoms of chronic venous insufficiency. Currently, the combination of systemic thrombolytic drugs followed by heparin is recommended for patients with acute major pulmonary embolism who are haemodynamically unstable. Streptokinase, urokinase and alteplase have all been shown to accelerate the lysis of pulmonary emboli and to decrease pulmonary vascular obstruction and pulmonary hypertension. Systemic venous or intrapulmonary infusions of alteplase offers the same benefit in terms of angiographic and haemodynamic improvement. A short infusion of 100 mg alteplase over 2 hours seems to be superior to a 24-hour infusion of urokinase. None of the thrombolytic trials in pulmonary embolism have been large enough to demonstrate a reduction in mortality. It is now generally accepted that, unless contraindicated, thrombolytic therapy is the front-line treatment for patients with massive pulmonary embolism and major haemodynamic disturbance. The local treatment of acute arterial occlusion in limb arteries results in rapid clearing of the artery in 67% of patients treated with streptokinase; the corresponding success rates for urokinase and alteplase are 81% and 88 to 94%, respectively. The main question appears to be the identification of patients in whom local thrombolysis is the treatment of choice, as opposed to established therapeutic modalities. Thrombolytic treatment following a major ischaemic stroke is hazardous, although clinical improvement has been noted in a minority of patients with recanalised cerebral arteries. The safety and efficacy of thrombolytic treatment remains unproven for this indication, and its use must be restricted to experimental protocols. Thrombolytic treatment in retinal artery or vein occlusion has, in practice, been abandoned.

SURGICAL RESULTS ON ACUTE ARTERIAL OCCLUSION OF THE EXTREMITIES WITH SPEICAL REFERENCE TO ARTERIOSCLEROTIC THROMBOSIS

The results of surgical treatment of acute arterial occlusion depend in its etiology. During a period of 15 years, from 1972 until 1987, arterial reconstrucitons for acute arterial occlusion were performed in 28 patients. Of these, occlusion was caused by embolism in 14 patients and by arteriosclerotic thrombosis in 14. In 14 ischemic limbs of the patients with embolism, simple embolectomy was performed with the Forgaty catheter. In patients with acute thrombosis of the arteriosclerotic artery, arterial bypass grafting or thromboendarterectomy was performed.Hospital death for embolectomy alone (0%) was lower than that for arteriosclerotic thrombosis (42%). Death was attributed to cardiac failure in 3 patients, panperitonitis in 2 patients and revascularization syndrome in 1 patient.The patency rate during hospitalization, including patients with a patent reconstructive tract at the time of death, was 100% in patients with embolism and 72% in those with arteriosclerotic thrombosis. Of the seven patients with arteriosclerotic thrombosis who were discharged from our clinic with limb salvage after operation, reconstructive tracts were patient in two and occluded in the others.The operative procedure should be tailored to the etiology of acute arterial occlusion.

急性動脈閉そく症における外科治療上の問題点

急性動脈閉そく症における外科治療上の問題点

Streptokinase in the treatment of acute arterial occlusion of the hand

Continuous, low-dose, intra-arterial streptokinase was used to treat six patients with ischemia of the hand secondary to distal arterial occlusion. A bolus dose of 100,000 U of streptokinase was administered, followed by a maintenance dose of 5000 U/hr, which was titrated against the patients' coagulation profile. The duration of infusion ranged from 16 to 96 hours. Recanalization was achieved in four patients who were treated within 36 hours of the onset of occlusion.

Augmentation of arterial collateral blood flow.

Still, if microcirculation fails, tissue nutrition is impaired and cardiovascular repair becomes futile.—<i>deTakats</i>¹ PERIPHERAL tissue oxygenation is poor in patients with single or multiple arterial occlusions which produce symptomatic ischemia. Distal blood flow is sluggish, the viscosity of capillary blood is increased, and the arteriolar pressure decreased. A self-perpetuating cyclic worsening of the ischemia develops and progresses until tissue necrosis supervenes. When distal arterial reconstruction is anatomically impossible or physiologically unsupportable, indirect means of augmenting microcirculatory flow becomes desirable. Heparinization has been utilized and found to be effective in forestalling irreversible tissue necrosis. Administration of dextran 40 has been utilized and shown to be beneficial by some in treatment of acute arterial occlusion.²Similarly, vasospastic and traumatic ischemia has been favorably influenced by infusion of dextran 40.³Even the ischemia of fat embolism has been satisfactorily treated using low molecular weight dextran.⁴ However, these clinical

Myoglobinuria after acute arterial occlusion.

MYOGLOBINURIA after acute interruption of the arterial supply to a limb has been reported in 2 patients, with thrombotic1 and embolic2 arterial occlusion, respectively. Despite the intense recent interest in the surgical treatment of acute arterial occlusion, we have been unable to find further reports of myoglobinuria secondary to this condition. Our experience with 2 patients recently studied leads us to believe that this sequence of events is more common than the paucity of case reports would imply.Case ReportsCase 1. H.A. (M.H. 104912), a 63-year-old man, was admitted to the hospital on March 27, 1959, for evaluation of . . .

Observations in the management of late arteriosclerosis obliterans with gangrene.

Article1 June 1957OBSERVATIONS IN THE MANAGEMENT OF LATE ARTERIOSCLEROSIS OBLITERANS WITH GANGRENEHARVEY L. MYERS, M.D., F.A.C.P.HARVEY L. MYERS, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-46-6-1137 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptOne rarely has the opportunity to observe the panorama of a single ailment unfold itself over a broad span of years. It has been my privilege to follow, at first hand, the clinical picture of arteriosclerosis obliterans associated with gangrene and/or ulceration of the extremities for the years following World War II, 1946 through 1956. During that decade 1,158 patients, 643 males and 515 females, were hospitalized at the Queens General Hospital with varying degrees of gangrene of the extremities associated with arteriosclerosis obliterans. Seventy-nine per cent of these people were over 60 years of age.Observations of these patients...Bibliography1. BollmanPreston VFW: The effects of experimental administration of dicoumarin, J. A. M. A. 129: 1021, 1942. CrossrefGoogle Scholar2. BarkerHinesKvale NWEAWF: The treatment of acute arterial occlusion of the extremities with special reference to anticoagulant therapy, Minnesota Med. 29: 250, 280, 1946. MedlineGoogle Scholar3. WesslerSilberg SNR: Studies in peripheral arterial occlusive disease, Circulation 7: 810, 1953. CrossrefMedlineGoogle Scholar4. DotterSteinbergBall CTIRB: Angiography, Circulation 3: 606, 1951. CrossrefMedlineGoogle Scholar5. Myers HL: Enzymatic debridement in the treatment of arteriosclerosis obliterans with gangrene, New York State J. Med. 53: 981, 1953. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Cedarhurst, N. Y.*Presented at the Thirty-eighth Annual Session of The American College of Physicians, Boston, Massachusetts, April 9, 1957.Requests for reprints should be addressed to Harvey L. Myers, M.D., 431 Broadway, Cedarhurst, N. Y. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 June 1957Volume 46, Issue 6Page: 1137-1142KeywordsAntibioticsAnticoagulant therapyAnticoagulantsCellulitisThrombosisUlcersVasodilation ePublished: 1 December 2008 Issue Published: 1 June 1957 PDF downloadLoading ...

Sympathetic denervation in the treatment of acute arterial occlusion.

The effect of sympathectomy on the size of the collateral vessels in acute arterial ligation in a hind limb was measured by an angiographic angiometric technic and by noting the pressure in the ligated artery distal to the ligature. The size of the largest collateral vessel present on the sympathectomized side was the same as that on the innervated side. The blood pressure in the ligated artery distal to the ligature was quite similar on the sympathectomized and innervated sides. The usual increase in temperature on the sympathectomized side was noted. This must be due to a shift of blood from the deeper tissues of the hind limb to the arteriovenous shunts of the skin of the toes, rather than to an increase in collateral blood flow.

Lumbar sympathectomy for arteriosclerotic gangrene.

THE VALUE of sympathetic block with procaine hydrochloride and of lumbar ganglionectomy in the treatment of acute arterial occlusion due to accidental arterial laceration, embolism, thrombophlebitis and its sequelae, Raynaud's disease, hyperhidrosis and certain instances of Buerger's disease is now well established. The use of sympathectomy for arterial deficiency due to arteriosclerosis, however, has not been generally accepted because of the extensive and irreversible changes which occur in the arteries in this disease and the frequency of failure of this type of treatment in poorly selected cases. In 1931 Flothow1reported 8 cases of arteriosclerosis of peripheral vessels in which improvement was obtained by injection of alcohol into lumbar sympathetic ganglions. Two of the patients had actual gangrene of one or more toes. In 1 of these the pain was relieved and the temperature of the skin raised 10 C. (18 F.). Although amputation was necessary at a later

Dicumarol: Its action, clinical use and effectiveness as an anticoagulant drug

Dicumarol is a potent and valuable anticoagulant drug. When used properly it appears to prevent intravascular thrombosis in almost all patients. There is considerable and unpredictable variation in sensitivity to dicumarol among different patients. Dosage of dicumarol must be guided by the effect produced in each patient as indicated by the degree and duration of prothrombin deficiency which develops and is indicated by determinations of the concentration of prothrombin in the blood. It is unwise to use dicumarol unless adequate facilities for determining the prothrombin time are available. If the prothrombin is kept between 10 and 30 per cent of normal by administration of dicumarol, thrombosis will almost certainly be prevented and serious bleeding is very unlikely to occur. The action of dicumarol is delayed. When a rapid anticoagulant effect is desired concurrent heparinization is necessary for the first few days. We have found that dicumarol has prevented fatal pulmonary embolism and recurrence or extension of venous thrombosis in patients who have had postoperative nonfatal pulmonary embolism or thrombophlebitis. There is some incomplete evidence to the effect that it will prevent peripheral thrombosis, pulmonary embolism and further coronary thrombosis in patients who have had acute myocardial infarction. Dicumarol with preliminary heparinization is valuable in the treatment of acute arterial occlusion of the extremities. It has also been used safely in patients in whom thrombophlebitis and pulmonary embolism complicated the puerperium and various diseases, in patients with idiopathic recurrent thrombophlebitis and in those with chronic occlusive arterial disease. While statistical confirmation is lacking, it is our impression that in many of these patients thrombosis and embolism have been prevented by administration of dicumarol.