National Audit of Thrombolysis for Acute Leg Ischemia (NATALI): clinical factors associated with early outcome

Earnshaw, J. J.; Whitman, Birgit; Foy, Chris

doi:10.1016/j.jvs.2004.01.019

Cited by 149 publications

(101 citation statements)

References 26 publications

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“…It is associated with a grave prognosis, with amputation rates ranging between 5% and 30% and mortality rates as high as 18%. 99,100 In the vast majority of cases, ALI is caused by peripheral embolization of intracardiac thrombus, typically due to atrial fibrillation. Other mechanisms include embolization of aneurysm-associated thrombus, iatrogenic causes from arterial catheterization, mechanical issues related to peripheral bypass grafts, paradoxical embolism, or in situ thrombosis of diffuse atherosclerosis.…”

Section: Acute Limb Ischemiamentioning

confidence: 99%

Endovascular Intervention for Peripheral Artery Disease

Thukkani

Kinlay

2015

Circulation Research

226

158

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Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated by exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have greater long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the main causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb.

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Section: Acute Limb Ischemiamentioning

confidence: 99%

Endovascular Intervention for Peripheral Artery Disease

Thukkani

Kinlay

2015

Circulation Research

226

158

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“…Patients with ALI often have multiple comorbid conditions that may affect their long-term prognosis despite successful thrombolysis. 24 This study also presented an opportunity, for the first time, to investigate the long-term results for different subgroups, depending on the underlying cause of ALI.…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia

Grip¹,

Wanhainen²,

Acosta³

et al. 2017

Journal of Vascular Surgery

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WHAT THIS STUDY ADDSReporting on the long-term outcome in a large cohort of patients treated with intra-arterial thrombolysis for acute lower limb ischaemia makes it possible to analyse the four main aetiological subgroups. Patients treated for occluded grafts, stents, or stent grafts had a higher risk of amputation and a lower amputation free survival, indicating the need for better treatment and follow-up. Re-interventions were most common after occluded grafts/stents/stent grafts, followed by occluded popliteal aneurysms, and native artery thrombosis, and least common after embolus. Overall, thrombolytic therapy achieved good medium and long-term clinical outcome and transformed an emergent into an elective situation. Objectives:The purpose was to study long-term outcome after thrombolysis for acute arterial lower limb ischaemia, and to evaluate the results depending on the underlying aetiology of arterial occlusion. Methods: This was a retrospective study of patients entered into a prospective database. Patients were identified in prospective databases from two vascular centres, including a large number of variables. Case records were analysed retrospectively. Through cross linkage with the Population Registry 100% accurate survival data were obtained. Between January 2001 and December 2013, 689 procedures were included. The aetiology of ischaemia was graft/stent/stent graft occlusion in 39.8%, arterial thrombosis in 27.7%, embolus in 25.1% and popliteal aneurysm in 7.4%. Results: The mean follow-up was 59.4 months (95% CI, 56.1e62.7), during which 32.9% needed further reinterventions, 16.4% underwent amputation without re-intervention, and 50.7% had no re-intervention. The need for re-intervention during follow-up was 48.0% in the graft/stent occlusions group, 34.0% of the popliteal aneurysm group, 25.4% in the thrombosis group, and 16.3% in the embolus group (p < .001). The overall primary patency rates were 69.1% and 55.9% at 1 and 5 years, respectively. Primary patency at 5 years was higher for the embolus group (83.3%, p ¼ .002) and lower for the occluded graft/stent group (43.3%, p < .001). Secondary patency rates were 80.1% and 75.2% at 1 and 5 years, respectively, without difference between the subgroups. The amputation rate was lower in the embolic group at 1 and 5 years (8.1% and 11.1%, respectively, p ¼ .001). Survival was higher in the group with occluded popliteal aneurysms at 5 years (83.3%, p ¼ 0.004). Amputation free survival was 72.1% and 45.2% at 1 and 5 years; lower in the occluded graft/stent group at five years (37.9%, p ¼ .007). Conclusion: Intra-arterial thrombolytic therapy achieves good medium and long-term clinical outcome, reducing the need of open surgical treatment in most patients.

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“…The documented global incidence of ALI is 1.5 cases per 10,000 population per year. The reported major amputation rate after ALI is 10-15% [2,3], while the associated 30-day mortality is 15-25% [4].…”

Section: Introductionmentioning

confidence: 99%

Atraumatic Acute Limb Ischemia: Clinical Presentation, Classification, Assessment and Management- A Review

Gunawansa¹

2017

Int J Vasc Surg Med

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Acute Limb Ischaemia (ALI) can be a devastating clinical emergency with potentially life or limb threatening consequences. The commonest aetiologies of ALI are traumatic, embolic or thrombotic. While traumatic ALI is fairly obvious in the trauma victim, embolic and thrombotic ALI may mimic other clinical conditions such as neurological disease which may cause delays in diagnosis. Immediate diagnosis, accurate assessment of limb viability and urgent intervention when needed play a crucial role in salvaging the affected limb and preventing a major amputation. Delay in diagnosis and intervention causes irreversible muscle ischaemia leading to eventual limb loss and potential systemic organ dysfunction due to associated lactic acidosis and other toxins.

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National Audit of Thrombolysis for Acute Leg Ischemia (NATALI): clinical factors associated with early outcome

Abstract: Experienced surgeons and radiologists can achieve an AFS of about 80% in selected patients with acute leg ischemia. Information from the NATALI database can be used in selection of an appropriate intervention in the individual patient.

Cited by 149 publications

References 26 publications

Endovascular Intervention for Peripheral Artery Disease

Endovascular Intervention for Peripheral Artery Disease

Long-term Outcome after Thrombolysis for Acute Lower Limb Ischaemia

Atraumatic Acute Limb Ischemia: Clinical Presentation, Classification, Assessment and Management- A Review

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