Comparison of thrombolytic therapy of lower-extremity acute, subacute, and chronic arterial occlusions

Wholey, Michael H.; Maynar, Manuel; Wholey, Mark H.; Pulido-Duque, J. M.; Reyes, Ricárdo; Jarmolowski, Chester R.; Castañeda, Wilfrido R.

doi:10.1002/(sici)1097-0304(199806)44:2<159::aid-ccd8>3.0.co;2-5

Cited by 79 publications

(53 citation statements)

References 25 publications

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“…According to our experience in 100% of cases where the infusion with uPA was completed, we obtained a restitution of a certain degree of patency, transforming all occlusions into stenoses, as did other authors (18,19).…”

Section: Discussionmentioning

confidence: 54%

Thrombolysis during the endovascular treatment of iliac artery occlusions

Taddei

Tamellini²,

Faccioli³

et al. 2009

Diagn Interv Radiol

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84C urrently the number of aortofemoral bypasses performed for iliac occlusive arterial pathology is decreasing (1-4). The causes of this turnaround are the increase of the patients' mean age and the increased frequency of concurrent pathologies. Moreover, surgery, which for a long time has been considered as the treatment of choice for this pathology, has almost completely been replaced by less invasive methodologies such as endovascular treatments (5-9). The role of thrombolysis to treat the iliac arterial occlusive pathology on an atherosclerotic basis during endovascular surgery is controversial. Although comparing experiences is difficult, the results of pharmacologic thrombolysis to treat iliac arterial obstructions with regard to the different methodologies of treatment, to the drugs used and to other nonstandardized variables seem encouraging (8). The first experiences with fibrinolytic therapy made us think it was unlikely that thrombolytic occlusions which had been present for longer than 1-2 weeks would adequately respond to these treatments. On the contrary, it was proved that injections of streptokinase or urokinase-type plasminogen activator (uPA) through the thrombus could also cause complete fibrinolysis in chronic occlusions (8). Recent thrombi (<15 days) are more sensitive to lysis, as shown by data from post-angioplasty thrombolysis (2, 5, 10). It is also true, however, that remarkable results may be achieved by using only percutaneous treatment angioplasty (PTA) associated with the stent technique (7).The purpose of this study was to assess the possible therapeutic advantage of thrombolysis prior to recanalization of iliac occlusions with PTA and stenting. Materials and methodsWe retrospectively evaluated 28 cases of iliac occlusions treated in 26 patients (in two cases there was a re-occlusion) over a six-year period. Our cases did not have contraindications for thrombolysis. No patients were diabetic. The presumed etiologies for the iliac occlusions were plaque thrombosis for acute patients and chronic atherosclerotic disease for chronic patients. Absolute contraindications were established such as cerebrovascular event (including transient ischemic attacks within last 2 months), active bleeding diathesis, recent gastrointestinal bleeding (<10 days), neurosurgery within last 3 months, and trauma within last 3 months (10, 11); relative major contraindications were cardiopulmonary resuscitation within last 10 days, major nonvascular surgery or trauma within last 10 days, uncontrolled hypertension (180 mmHg systolic or 110 mmHg diastolic), puncture of non-compressible vessel, intracranial tumor, and eye surgery; minor contraindications were hepatic failure, particularly those with coagulopathy, bacterial endocarditis, pregnancy, and hemorrhagic retinopathy (10, 11). INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE Thrombolysis during the endovascular treatment of iliac artery occlusionsGiuseppe Taddei, Paolo Tamellini, Faccioli Niccolo, Iannello Antonio PURPOSEThe purpose of this study was to assess...

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Section: Discussionmentioning

confidence: 54%

Thrombolysis during the endovascular treatment of iliac artery occlusions

Taddei

Tamellini²,

Faccioli³

et al. 2009

Diagn Interv Radiol

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“…One published study reported an immediate distal thromboembolic rate of 5.3%, with similar results for acute and subacute versus chronically occluded lesions [10]. A report on peri-operative distal embolization following intervention for chronic iliac artery occlusion gives a rate of 2.9% [11]. Some reports on distal embolization during intra-arterial thrombolysis have reported rates of 8.3–24% [12, 13].…”

Section: Discussionmentioning

confidence: 91%

The Results of a New Distal Protection Method in Intervention for Chronic Total Occlusion of the Superficial Femoral Artery

Kobayashi

Funatsu

Ejima

et al. 2009

Cardiology Research and Practice

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Aims. To determine the efficacy of a new distal protection method in SFA CTO interventions. Methods and Results. From June 2003 to February 2009, ninety-two consecutive, chronic total occlusions of superficial femoral arteries were treated with catheter-based intervention using a bidirectional approach. Nine of these cases were managed with our original, distal protection method, based on symptoms, angiographic images, wire resistance, and intravascular ultrasound images. The average age was 73 years; eight patients were male. The mean occlusion length was 17.1 cm. A distal protection balloon was inserted from the retrograde sheath in the popliteal artery and placed distal to the occluded lesion after successful wire crossing. Lesion dilatation with a balloon was performed antegradely and debris was removed by 6Fr. guiding catheter. Debris was retrieved from all lesions, consisting mainly of thrombus. Where we decided not to use the distal protection method, there was no distal thromboembolism. Conclusion. In SFA-CTO intervention, the risk of distal embolization is 10%, which can be anticipated and eliminated by the distal protection method.

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“…Most preclinical published literature (6,7,11,14,15) examines reperfusion of acute thrombus (<12 h). However, thrombus composition and response to thrombolytic agents change with time (23,33,34). The present study's model had the advantage of reproducing the clinical scenario with respect to graft material, physiology of graft failure, thrombus burden, and maturation.…”

Section: Discussionmentioning

confidence: 99%

Pulsed High–Intensity-focused US and Tissue Plasminogen Activator (TPA) Versus TPA Alone for Thrombolysis of Occluded Bypass Graft in Swine

Abi-Jaoudeh

Pritchard

Amalou

et al. 2012

Journal of Vascular and Interventional Radiology

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Purpose Prosthetic arteriovenous or arterial-arterial bypass grafts can thrombose and be resistant to revascularization. A thrombosed bypass graft model was created to evaluate the potential therapeutic enhancement and safety profile of pulsed high-intensity-focused ultrasound (pHIFU) on pharmaceutical thrombolysis. Materials and Methods In swine, a right carotid-carotid expanded polytetrafluoroethylene bypass graft was surgically constructed, containing a 40% stenosis at its distal end to induce graft thrombosis. The revascularization procedure was performed 7 days after surgery. After model development and dose response experiments (n = 11), two cohorts were studied: pHIFU with tissue plasminogen activator (TPA; n = 4) and sham pHIFU with TPA (n = 3). The experiments were identical in both groups except no energy was delivered in the sham pHIFU group. Serial angiograms were obtained in all cases. The area of graft opacified by contrast medium on angiograms was quantified with digital image processing software. A blinded reviewer calculated the change in the graft area opacified by contrast medium and expressed it as a percentage, representing percentage of thrombolysis. Results Combining pHIFU with 0.5 mg of TPA resulted in a 52% ± 4% increase in thrombolysis on angiograms obtained at 30 minutes, compared with a 9% ± 14% increase with sham pHIFU and 0.5 mg TPA (P = .003). Histopathologic examination demonstrated no differences between the groups. Conclusions Thrombolysis of occluded bypass grafts was significantly increased when combining pHIFU and TPA versus sham pHIFU and TPA. These results suggest that application of pHIFU may augment thrombolysis with a reduced time and dose.

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Comparison of thrombolytic therapy of lower-extremity acute, subacute, and chronic arterial occlusions

Cited by 79 publications

References 25 publications

Thrombolysis during the endovascular treatment of iliac artery occlusions

Thrombolysis during the endovascular treatment of iliac artery occlusions

The Results of a New Distal Protection Method in Intervention for Chronic Total Occlusion of the Superficial Femoral Artery

Pulsed High–Intensity-focused US and Tissue Plasminogen Activator (TPA) Versus TPA Alone for Thrombolysis of Occluded Bypass Graft in Swine

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