Thrombolysis of lower extremity embolic occlusions: a study of the results of the STAR Registry.

Huettl, Eric A.; Soulen, Michael C.

doi:10.1148/radiology.197.1.7568812

Cited by 35 publications

(17 citation statements)

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“…Autogenous grafts also respond poorly to thrombectomy, being highly likely to have a fixed stenotic lesion requiring further intervention, and repeat bypass grafting is recommended by some as the appropriate primary approach in these patients. Overall restored patency rates vary from 60 to 90 % [64,65], and conduits treated successfully have a long-term patency reported at up to 80 % or more, if an underlying cause for graft failure is identified and treated. This compares well with surgical thrombectomy.…”

Section: Resultsmentioning

confidence: 99%

Thrombolysis in the peripheral vascular system

2001

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The technique of thrombolysis is now well established, becoming employed increasingly often in disease of the peripheral vasculature, both arterial and venous, in addition to its important role in the treatment of coronary artery thrombosis. This is a general review of its applications in peripheral vascular disease causing acute lower limb ischaemia, currently the major indication for its use outside the coronary circulation.

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Section: Resultsmentioning

confidence: 99%

Thrombolysis in the peripheral vascular system

2001

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“…Catheter-directed thrombolysis is generally well accepted; however, success rates for thrombotic and embolic occlusions in the lower extremities average 81% and 76%, respectively (22–24). Moreover, effective thrombolytic therapy requires proper catheter placement, long treatment duration, and the need for surgical reconstruction or endo-vascular procedures after thrombolysis (10,22).…”

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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“…If the ischemia has progressed but is possibly reversible, surgical options might be more timely, considering the time it takes to perform thrombolysis. Thrombolytic therapy has proved to be effective, with minimal risk of hemorrhagic complications, and reduces the need for surgical procedures with similar limb salvage rates (6,19,20). Other interventional techniques involve mechanical thrombectomy devices that decimate or suction the thrombus (21,22).…”

Section: Arterial Embolusmentioning

confidence: 99%

Popliteal Artery Disease: Diagnosis and Treatment

Wright¹,

Matchett²,

Cruz³

et al. 2004

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The popliteal artery is a relatively short vascular segment but is affected by a unique set of pathologic conditions. These conditions, which may be common throughout the arterial system or exclusive to the popliteal artery, include atherosclerosis, popliteal artery aneurysm, arterial embolus, trauma, popliteal artery entrapment syndrome, and cystic adventitial disease. The clinical manifestations, imaging appearances, and treatment options associated with these pathologic conditions differ significantly. Consequently, the radiologist should be familiar with these conditions to direct imaging for accurate diagnosis and treatment and to prevent loss of limb.

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Thrombolysis of lower extremity embolic occlusions: a study of the results of the STAR Registry.

Abstract: Thrombolysis of embolic occlusions is successful in most cases. Limb salvage and survival rates are similar to historical reports for surgical embolectomy.

Cited by 35 publications

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Thrombolysis in the peripheral vascular system

Thrombolysis in the peripheral vascular system

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

Popliteal Artery Disease: Diagnosis and Treatment

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