Assessment of Peripheral Intraarterial Thrombolysis versus Surgical Revascularization in Acute Lower-Limb Ischemia: A Review of Limb-Salvage and Mortality Statistics

Diffin, Daniel C.; Kandarpa, Krishna

doi:10.1016/s1051-0443(96)70734-0

Cited by 68 publications

(32 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The mean time required to remove thrombus with Hydrolyser was 10 min (each run lasted approximately 50 s). The mean number of runs necessary to achieve restoration of blood flow was four [2][3][4][5][6][7][8][9]. The fluid in the collector bag contained the injected volume of saline solution, fragmented clots and blood.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Percutaneous recanalization of acutely thrombosed vessels by hydrodynamic thrombectomy (Hydrolyser)

et al. 1997

View full text Add to dashboard Cite

A hydrodynamic thrombectomy catheter was prospectively evaluated for the treatment of recently thrombosed vessels. A total of 52 consecutive patients (42 males and 10 females; mean age 64 +/- 15 years) presenting with acute or subacute occlusion of dialysis shunts (n = 25), peripheral bypass (n = 14) or native arteries (n = 15) were treated with the Hydrolyser (Cordis Europa NV, Roden, The Netherlands). Mean occlusion time was 4 days (range 1-17 days) and mean thrombus length 19 +/- 11 cm. The Hydrolyser was effective and fast in removing thrombus, regardless of the thrombus length. No major complications were reported. The immediate procedure success rates were 82, 100, 87 and 79 % for Brescia Cimino, dialysis shunt, native arteries and bypass grafts, respectively. Adjunctive thrombolysis (applied for persistence of residual thrombus or thrombosed distal vessels too small for hydrolytic thrombectomy) was required in 4 % of thrombotic dialysis shunts, in 20 % of native arteries and in 50 % of bypass graft occlusions. On angiographic controls, distal embolizations were reported only in native arteries (13 %) and bypasses (14 %); all were successfully treated percutaneously, except for one case treated by Fogarty balloon. Cumulative primary patency rates were respectively at 6 months 56, 62, 78 and 65 % for each indication. We conclude from this preliminary clinical study that hydrodynamic thrombectomy with a Hydrolyser is a promising technique to treat acute occlusions. This device can reduce complications as well as the time required to remove large amounts of thrombus and the use of expensive thrombolytic drugs.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Surgical thrombectomy with Fogarty balloon, although relatively easy and fast, results often in incomplete restoration of blood flow and intimal damage [1,8]. Percutaneous thromboaspiration can be effective [9,10], but unfortunately, significant blood loss can be encountered with long thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous recanalization of acutely thrombosed vessels by hydrodynamic thrombectomy (Hydrolyser)

et al. 1997

View full text Add to dashboard Cite

show abstract

“…However, initial management with surgery compared to thrombolysis was found to more often require subsequent operative intervention at 30 days (odds ratio = 5.37; 95% confidence interval 3.99À7.22). Furthermore, surgical intervention for ALI in elderly patients was associated with mortality rates as high as 29% (13). Overall, despite similar outcomes, the authors concluded that the higher overall complication rate with thrombolysis must be balanced against the risk of surgery in each patient (8).…”

Section: Treatment Decision-making Processmentioning

confidence: 99%

Acute Limb Ischemia: A Case Report and Literature Review

Braun

Lin

2015

The Journal of Emergency Medicine

View full text Add to dashboard Cite

, Abstract-Background: Acute limb ischemia (ALI), although uncommon, can present with profound symptoms, including disabling pain in the setting of acute vascular and neurologic deficits. The most appropriate diagnostic and therapeutic strategy has evolved with emerging technologies inclusive of less-invasive endovascular diagnostic and therapeutic options. Objective: We present a case of ALI to illustrate the diagnostic and therapeutic approaches with a summary of the most common literature. Discussion: Utilizing the clinical findings applied to the Rutherford classification, the emergency physician, in consultation with a vascular surgeon and interventional radiologist, can strategize a methodical approach for better clinical outcomes, often with less-invasive endovascular interventions, ideally within 6 h of symptom onset. Conclusions: We present a case of ALI to illustrate the diagnostic and therapeutic approach with a summary of the most current literature. Emergency physicians should be aware of optimized clinical outcomes with the use of time-sensitive enhanced endovascular therapies as a recommended option for the best outcomes for the treatment of ALI. Ó 2015 Elsevier Inc.

show abstract

“…Die bisher publizierten Studien lassen offen, welches Fibrinolytikum in Abhängigkeit von seiner Dosierung mit den besten Ergebnissen und niedrigsten Komplikationsraten einhergeht [14]. [27].…”

Section: Thrombolyseverfahrenunclassified

Akute periphere arterielle Verschlusskrankheit

Schumann¹,

Rieger²,

Ludwig³

2007

Med Klin

View full text Add to dashboard Cite

Acute lower limb ischemia is not infrequently associated with limb loss 10-30%) or death of the affected patient (15-30%). Thus, acute lower limb ischemia is an emergency. There are two categories of acute arterial occlusion: embolism (70-80%) and thrombosis (20-30%). Early diagnosis is a prerequisite for optimal management. Initial clinical examination is the crucial point: it makes the diagnosis of acute ischemia, localizes the level of occlusion, collects etiologic information and allows for assessing the local and general impact of ischemia on the patient. If sensation and motor function are present, viability of the limb is not threatened (incomplete limb ischemia), and good results can be obtained by utilizing anticoagulation and delayed elective revascularization, if the latter is indicated. If the patient, however, presents symptoms of a complete limb ischemia (paralysis or anesthesia is present), then ultimate limb loss is likely. Most patients present with subtle findings and lack classic symptoms, which makes the diagnosis difficult. The standard office-based tests to determine the presence of acute peripheral vascular disease are calculation of the ankle-brachial index and color duplex sonography. Up to now, digital subtraction angiography is used as standard of reference for definitive localization of the occlusion before revascularization. Magnetic resonance arteriography may be helpful when symptoms or findings do not correlate with the noninvasive ultrasound methods. Therapeutic choices are high-dose heparin therapy, surgical removal of the clot, mechanical interventional thrombectomy, and/or catheter-directed thrombolysis - the ultimate choice being dependent on the particular status of the patient. Patients with severe ischemia require immediate surgical intervention. In patients with contraindications to surgical management or incomplete ischemia, interventional revascularization is the therapy of primary choice. Successful outcome is dependent on careful clinical assessment and a prompt multidisciplinary approach to revascularization.

show abstract

Assessment of Peripheral Intraarterial Thrombolysis versus Surgical Revascularization in Acute Lower-Limb Ischemia: A Review of Limb-Salvage and Mortality Statistics

Cited by 68 publications

References 34 publications

Percutaneous recanalization of acutely thrombosed vessels by hydrodynamic thrombectomy (Hydrolyser)

Percutaneous recanalization of acutely thrombosed vessels by hydrodynamic thrombectomy (Hydrolyser)

Acute Limb Ischemia: A Case Report and Literature Review

Akute periphere arterielle Verschlusskrankheit

Contact Info

Product

Resources

About