Outcome of catheter directed thrombolysis for popliteal or infrapopliteal acute arterial occlusion
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ORIGINAL ARTICLE
Outcome of catheter directed thrombolysis for popliteal or infrapopliteal acute arterial occlusion Mohammed Hassan Abdelaty1 · Amr Mahmoud Aborahma1 · Mohammed Ahmed Elheniedy1 · Adel Husseiny Kamhawy1 Received: 29 May 2020 / Accepted: 27 August 2020 © Japanese Association of Cardiovascular Intervention and Therapeutics 2020
Abstract Management of acute limb ischemia (ALI) due to occlusions in popliteal and infrapopliteal arteries remains a challenge. Open surgical methods and even the novel percutaneous mechanical thrombectomy devices have not shown satisfactory results in these small arteries. The aim of this prospective study was to assess the safety and efficacy of catheter-directed thrombolysis (CDT) in this type of ALI with distal occlusion. Between April 2017 and June 2019, 22 patients with ALI secondary to popliteal or infrapopliteal occlusion were enrolled in the study. Patients with thrombosis, embolism, and thrombosed bypass graft were included; all belong to category I or IIa of Rutherford’s classification. Technical success, limb salvage, complications, and mortality were evaluated at short- and long-term follow-up. Technical success was achieved in 81.8%, while 36.4% of patients needed additional balloon angioplasty, major amputation in 13.6%, minor bleeding in 18.2%, and no major hemorrhage. Limb salvage at 30 days and 1 year was 86.4% and 72.7%, respectively. At 1 year, primary patency was 63.6% and mortality was 9.1%. Catheter directed thrombolysis is a safe and highly effective treatment modality for popliteal or infrapopliteal acute limb ischemia unless contraindicated. Keywords Acute limb ischemia · Catheter directed thrombolysis · Popliteal artery · Thrombosis · Embolism · Amputationfree survival
Introduction Acute limb ischemia (ALI) is defined as a sudden decrease in limb perfusion causing a potential threat to the limb viability within 14 days or less [1]. Acute lower limb ischemia affects approximately 1–1.5 per 10,000 persons annually, the mean age of ALI is 76.3 years [2]. Mortality rates reach 12.4% in the early follow-up period (30 days) [3] and 35% in 2-year follow-up [4]. Thrombosis on top of atherosclerosis is the most common cause of ALI, followed by embolism, and thrombosis of a bypass graft [5]. The clinical presentations are variable depending mainly on the etiology and duration of ischemia [6].
* Mohammed Hassan Abdelaty [email protected] 1
Department of Vascular and Endovascular Surgery, Faculty of Medicine, Tanta University, El Geish Street, Tanta 31527, Egypt
The severity of ALI is commonly assessed by Rutherford’s classification, the importance of this classification comes from its impact on the management and prognosis. The management decision is made according to the type and level of occlusion, duration of ischemia, Rutherford’s classification, and patient’s comorbidities. Options include medical treatment, open surgery, and endovascular therapy, either catheter directed thrombolysis (CDT) or percutaneous mechanical thrombectomy (P
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