Thrombolysis in Acute Lower Limb Ischemia: Review of the Current Literature

Theodoridis, Panagiotis G.; Davos, Constantinos H.; Dodos, Ilias; Iatrou, Nikolaos; Potouridis, Anastasios; Pappas, Georgios M; Staramos, Dimitrios N.; Antoniadis, Pavlos; Argitis, V.; Dervisis, Konstantinos

doi:10.1016/j.avsg.2018.02.030

Cited by 40 publications

(28 citation statements)

References 31 publications

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“…In-situ thrombosis commonly occur within diseased native artery (ruptured atherosclerotic plaque, aneurysm, arterial dissections), prior surgical bypass grafts or vascular prosthesis, and trauma. Arterial aneurysms, most frequently popliteal, can rapidly become an emergent limb and life-threatening condition with high morbidity and mortality [1,12]. Aneurysms can present with both severe distal embolism affecting outflow arterial beds along with thrombosis of the aneurysmal segment.…”

Section: Clinical Staging and Etiologymentioning

confidence: 99%

Endovascular Strategies in the Management of Acute Limb Ischemia

Lind

Morcos

Ferral

et al. 2019

VSI

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Acute limb ischemia (ALI) represents one of the most common emergent scenarios encountered by a vascular specialist. Despite expedient revascularization, high rates of limb loss are reported along with high mortality rates which are second only to ruptured abdominal aortic aneurysms. Surgical revascularization is standard of care. Endovascular techniques as an alternative have emerged to be appropriate first line therapy when addressing the threatened limb. We review the etiology and classification of ALI and current endovascular techniques and evidence to date in the management of patients acutely presenting with extremity ischemia.

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Section: Clinical Staging and Etiologymentioning

confidence: 99%

Endovascular Strategies in the Management of Acute Limb Ischemia

Lind

Morcos

Ferral

et al. 2019

VSI

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“…Continuous unfractionated heparin infusion during thrombolysis is thought to increase the efficacy of lysis by preventing rethrombosis and is utilized by most interventionalists. 3,9,28,29,33 Small series, however, show no improvement in efficacy with similar complication rates without or with heparinization during thrombolysis. 9,11 Similarly, adjunctive administration of platelet glycoprotein IIb/IIIa antagonists has been proposed to accelerate natural thrombolysis.…”

Section: Pharmacologymentioning

confidence: 99%

Acute Limb Ischemia Therapies: When and How to Treat Endovascularly

Hage

McDevitt

Vadlamudi

2018

Semin intervent Radiol

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Acute limb ischemia is an emergent limb and life-threatening condition with high morbidity and mortality. An understanding of the presentation, clinical evaluation, and initial workup, including noninvasive imaging evaluation, is critical to determine an appropriate management strategy. Modern series have shown endovascular revascularization for acute limb ischemia to be safe and effective with success rates approaching surgical series and with similar, or even decreased, perioperative morbidity and mortality. A thorough understanding of endovascular techniques, associated pharmacology, and perioperative care is paramount to the endovascular management of patients presenting with acute limb ischemia. This article discusses the diagnosis and strategies for endovascular treatment of acute limb ischemia.

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“…1,2 Catheter-directed thrombolysis offers a minimally invasive approach to anatomically complex lesions in patients who may not be candidates for open surgery. 3…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Catheter-directed thrombolysis offers a minimally invasive approach to anatomically complex lesions in patients who may not be candidates for open surgery. 3 Currently, there are several catheter-based delivery systems that perform safe and effective CDT in the setting of ALI, with some products offering adjunctive fibrinolytic and thrombectomy mechanisms. Ultrasound-accelerated thrombolysis (UAT) has demonstrated safety and efficacy in previous studies utilizing the EKOS EndoWave Infusion Catheter (BTG, London, United Kingdom), 4,5 with duration of thrombolysis shorter than reported in the initial TOPAS trial.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Ultrasound-Accelerated Versus Multi-Hole Infusion Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia

Chait

Aurshina

Marks

et al. 2019

Vasc Endovascular Surg

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Objective: Thrombolytic therapy is widely used in the treatment of arterial occlusions causing acute limb ischemia (ALI); however, knowledge regarding the efficacy of the different catheter systems available is scarce. The objective of this study was to compare the safety and efficacy of 2 catheter-directed infusion systems for intra-arterial thrombolysis in the setting of ALI. Methods: A retrospective analysis was conducted to study all catheter-directed thrombolysis procedures performed over 32 months in patients diagnosed with ALI. Patients with thrombosis in both native arteries and bypass grafts were included. Patients with contraindications to thrombolysis, or those receiving thrombolysis for deep venous thrombosis, were excluded. The duration of thrombolysis, amount of thrombolytic agent, and technical success rate were recorded. Technical success was defined as complete or near-complete resolution of thrombus burden, allowing for further intervention. Data were stratified to include location of thrombus, procedural complications, mortality, and rates of limb loss. Results: Ninety-one patients met inclusion criteria. Among them, Uni-Fuse and EKOS catheters were used in 69 and 22 patients, respectively. The mean age of the population was 71 (standard deviation [SD]: ±1.5) for patients treated with the EKOS catheter and 70 years (SD: ±2.6) for patients receiving thrombolysis with Uni-Fuse. There was no significant difference in the mean infusion duration (1.65 vs 1.9 days), volume of tissue plasminogen activator (44.6 vs 48.2 mg), or technical success rate (72% vs 86%) between the Uni-Fuse and EKOS cohorts ( P > .3). Furthermore, there was no difference in major limb loss or compartment syndrome between each group ( P > .4). The overall complication rate was 14% in both groups, with a 30-day mortality rate of 4% when treated with either catheter system. Conclusion: This study suggests that a standard multi-hole infusion catheter demonstrates similar clinical safety and efficacy as the ultrasound-accelerated EKOS system in the treatment of ALI.

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Thrombolysis in Acute Lower Limb Ischemia: Review of the Current Literature

Cited by 40 publications

References 31 publications

Endovascular Strategies in the Management of Acute Limb Ischemia

Endovascular Strategies in the Management of Acute Limb Ischemia

Acute Limb Ischemia Therapies: When and How to Treat Endovascularly

Comparison of Ultrasound-Accelerated Versus Multi-Hole Infusion Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia

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