Surgical revascularization versus thrombolysis for nonembolic lower extremity native artery occlusions: Results of a prospective randomized trial

Weaver, Fred A.; Comerota, Anthony J.; Youngblood, Marston; Froehlich, Juergen; Hosking, James D.; Papanicolaou, George

doi:10.1016/s0741-5214(96)70067-8

Cited by 247 publications

(129 citation statements)

References 8 publications

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“…As explained in the Introduction, the method is capable of replacing intra-arterial thrombolysis in most cases. The immediate results of rotational thrombectomy are probably more favourable than those following thrombolysis and the complication rate is lower [1,3,6,7]. Nevertheless, we are aware that the comparison of these results with large thrombolytic studies (e.g.…”

Section: Discussionmentioning

confidence: 97%

“…Nevertheless, we are aware that the comparison of these results with large thrombolytic studies (e.g. STILE, TOPAS) may be misleading as these studies have a completely diff erent design, since they compare thrombolytic treatment with surgical treatment [6,7]. Randomised, multicentre trials comparing thrombolysis with Rotarex mechanical thrombectomy are not yet available.…”

Section: Discussionmentioning

confidence: 99%

“…The TOPAS study described a 65 % amputation-free survival rate at one year in the urokinase group. In the STILE study, ischemia recurred in 64 % of patients at one year in the thrombolysed group, with an incidence of amputations in 10 % of patients during the fi rst year after the procedure [6,7]. However, as mentioned above in the discussion of immediate results, any comparison must be made very carefully…”

Section: Follow-upmentioning

confidence: 99%

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Percutaneous mechanical thrombectomy in the treatment of acute and subacute occlusions of the peripheral arteries and bypasses

Staněk

Ouhrabková

Prochazka

2016

Vasa

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Summary:Background: The aim of this prospective single-centre study was to analyse the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries and bypasses, as well as to evaluate long-term outcomes of this method. Patients and methods: Patients with acute (duration of symptoms < 14 days) or subacute (duration of symptoms > 14 days and < 3 months) occlusions of peripheral arteries and bypasses were selected consecutively for treatment. The cohort consisted of 113 patients, aged 18 -92 years (median 72 years). In all, 128 procedures were performed. Results: Angiographic success was obtained in 120 interventions (93.8 %). Reasons for failures were rethrombosis of a partially recanalised segment in six procedures, and embolism into crural arteries in one intervention -percutaneous aspiration thromboembolectomy (PAT) and/or thrombolysis were ineffective in all these cases. Breakage of the Rotarex catheter happened in one procedure. Embolisation into crural arteries as a transitory complication solvable with PAT and/or thrombolysis occurred in four cases. Rethrombosis was more frequent in bypasses than in native arteries (p = 0.0069), in patients with longer occlusions (p = 0.026) and those with poorer distal runoff (p = 0.048). Embolisation happened more often in patients with a shorter duration of symptoms (p = 0.0001). Clinical success was achieved in 82.5 %. Major amputation was performed in 10 % of cases. Cumulative patency rates were 75 % after one month, 71 % after six months, 38 % after 12 months, 33 % after 18 months and 30 % after 24, 30, 36 and 42 months. Conclusions: Rotarex thrombectomy has excellent immediate results with a low rate of failures and complications. In comparison to thrombolysis, it enables the fast and effi cient treatment of acute and subacute occlusions of peripheral arteries in one session.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Follow-upmentioning

confidence: 99%

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Percutaneous mechanical thrombectomy in the treatment of acute and subacute occlusions of the peripheral arteries and bypasses

Staněk

Ouhrabková

Prochazka

2016

Vasa

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“…The third landmark study was the Thrombolysis or Peripheral Arterial Surgery (TOPAS) trial [30]. It employed 544 patients with short duration ALI (<14 days) and randomized to urokinase based thrombolysis versus surgery.…”

Section: Catheter-directed Thrombolysis (Cdt)mentioning

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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“…A very important step in the protocol is the assessment of the exact location of the thrombosis, as this affects the decision making for the basic therapeutic plan. For example, it is better to treat Aorto-femoral segments surgically (Weaver et al, 1996), while subinguinal areas are more feasible for treatment by angioplasty, thrombolysis, or by a combination of both (Weaver et al, 1996).…”

Section: Treatment Options For Acute Peripheral Thrombosismentioning

confidence: 99%

Heparin and its derivatives in the treatment of arterial thrombosis: a review

Dvořák¹,

Vlašín²,

Dvorakova³

et al. 2010

Vet. Med. - Czech

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Arterial occlusion due to thrombosis caused by ruptured atherosclerotic plaques (Baba et al., 1975) has been recognized as a major cause of morbidity and mortality in western populations. Thrombosis may occur in various sections of arterial circulation, peripheral arteries of the limbs, coronary arteries, brain arteries, or both major and minor vessels within the abdominal cavity. The ultimate consequence is varying degrees of organ failure, mostly of ischemic origin. Arterial thrombosis represents a continuous problem, debilitating patients and decreasing their quality of life. Moreover, along with chronic heart failure, it can significantly decrease patient life expectancy. Arterial thrombosis results in ischemia, with serious systemic consequences, such as metabolic breakdown. The major goal of treatment remains fast and efficient recanalization -surgical, interventional or thrombolytic. To be able to prevent acute reocclusion with severe consequences (rhabdomyolysis, compartment syndrome, excessive tissue necrosis leading to limb amputation, etc.), several adjunctive treatment regimens have been advocated. Among others, thrombin inhibitors and platelet inhibitors have been widely used for both prophylaxis and adjunctive treatment. Direct thrombin inhibitors and antithrombin stimulators have been recognized as typical antithrombotic drugs. Direct (antithrombin-independent) thrombin inhibitors can be divided into two main categories: monovalent, active site inhibitors (argatroban, efegatran, inovastan, melagatran) and bivalent (hirudin, hirugen, hirulog, bivalirudin), while antithrombin stimulators represent standard (unfractionated) heparin (UFH) and its depolymerizing products -low molecular weight heparins (LMWH's). Recently, a clear change in the main use of heparin, as well as low-molecular weight heparins has been advocated representing a shift from treatment and prophylaxis of deep vein thrombosis to prophylaxis of thromboembolic disease following vascular, cardiovascular or orthopedic surgery, treatment of unstable angina and prevention of acute myocardial infarction. The main effect of heparins lies in their anticoagulant activity. Heparins are involved in different pathways of the coagulation cascade with anticoagulant, antithrombotic, profibrinolytic, anti-aggregative, as well as anti-inflammatory effects. Moreover, there is a little doubt about their anti-proliferative and anti-ischemic activity (Penka and Bulikova, 2006). Unlike standard heparin, low-molecular weight heparins do not affect the patient's general coagulation profile. Obviously, the difference in molecular weight results in different pharmacokinetic and pharmacodynamic properties of the agents.Key words: coagulation; arterial thrombosis; standard heparin; low-molecular weight heparins List of abbreviations ABI = axillary/...index, t-PA = tissue-type plasminogen activator, ADP = adenosin diphosphate, AG = angiography, AMI = acute myocardial infarction, APSAC = acylated plasminogen streptokinase activator complex, APTT = acti...

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Surgical revascularization versus thrombolysis for nonembolic lower extremity native artery occlusions: Results of a prospective randomized trial

Cited by 247 publications

References 8 publications

Percutaneous mechanical thrombectomy in the treatment of acute and subacute occlusions of the peripheral arteries and bypasses

Percutaneous mechanical thrombectomy in the treatment of acute and subacute occlusions of the peripheral arteries and bypasses

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

Heparin and its derivatives in the treatment of arterial thrombosis: a review

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