Thrombolysis during the endovascular treatment of iliac artery occlusions

Abstract

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surgery, which for a long time has been considered as the treatment of choice for this pathology, has almost completely been replaced by less invasive methodologies such as endovascular treatments (5-9).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...