Introduction:

Over the past few decades management options of the acute limb ischaemia (ALI) have changed. Nowadays, catheter direct thrombolysis (CDT) is commonly used as an alternative to surgery in immediate management of the ALI and may offer certain advantages over surgery in appropriately selected patients.

Objective:

To evaluate CDT data for the treatment of acute ischaemia in lower extremity in different aetiologies.

Materials and methods:

All consecutive patients who underwent CDT for acute limb ischaemia in our vascular surgery department, between 1 January 2011 to 31 August 2017 were identified and reviewed. Outcome measures included primary patency at 30 days and one year, haemorrhagic complications, major amputation and mortality.

Results:

In total, 128 limbs from 106 patients were included. The median follow-up was 14 months [range: 6-31 months]. The aetiologies of ischaemia included in the study were native artery thrombosis, PTFE and GSV bypass thrombosis, intra-stent thrombosis, popliteal aneurysm and entrapment thrombosis and arterial embolism. The Stages of ALI according to the Rutherford classification were 12,5% in class I, 77,3% in class IIa and 10,2% in class IIb. Primary patency rates were 71.3% and 47.8% at one and three years, respectively. The requirement for re-intervention was 27.6% in the native artery thrombosis group, 65.2% in the PTFE graft thrombosis group, and 18.2% in the intra-stent thrombosis group. No re-interventions were verified for popliteal aneurysm or arterial embolism aetiologies. The overall amputation free survival was 83.3% at 27 months, and the cumulative incidence of death was 10.1% at 32 months. Complications occurred in 40 interventions (31.3%); the majority comprised minor bleeding from the access site, and one death due to haemorrhagic stroke.

Conclusions:

CDT although associated with an increased risk of bleeding complications, it is a feasible and safe therapy, with clinical outcomes that may reduce the need for open surgical treatment in many patients. Our findings support this therapeutic approach as a valid option in ALI, in different aetiologies.

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