Publication:

Catheter directed thrombolysis in management of early acute thrombotic ischemia: early experience

Background To assess the effectiveness of catheter directed thrombolysis in management of early acute thrombotic ischemia.

Methods A prospective study was carried out on 18 patients (13 males, 5 females) with a mean age of 49 years (ranged from 45 - 69 years) suffered from acute thrombotic lower limb ischemia (Rutherford II- a) and submitted to catheter directed thrombolysis (CDT) using tissue plasminogen activator (TPA) between August 2015 to March 2017. The commonest thrombosed artery was superficial femoral artery (SFA). Major risk factors were diabetes and smoking (66% and 56%) respectively. The infusion method was lacing technique followed by continuous infusion.

Results Technical success was obtained in 15 patients (83%). Complementary revascularization was performed in 5/15 patients (33.3 %) by balloon angioplasty. Limb salvage rate at 6 months was (77.7%). Failure of thrombolysis occurred in 3 limbs (16.6%); one patient treated by femoro-popliteal bypass while the other two limbs ended by amputation. Regarding complications, bleeding (local groin hematoma or minimal retroperitoneal hematoma) occurred in 3 patients (16.6 %). No major bleeding was recorded. Amputation had performed in 2 cases (11%) while mortality rate within 6 months was 16.6 %.

Conclusions With proper patient selection, CDT should be considered the first-line treatment for patients with (Rutherford II- a) acute thrombotic limb ischemia.