Percutaneous catheter thrombus aspiration for acute or subacute arterial occlusion of the legs: how much thrombolysis is needed?

Eur J Vasc Endovasc Surg. 2000 Jul;20(1):41-6. doi: 10.1053/ejvs.2000.1117.

Abstract

Objective: To evaluate the role of a combined percutaneous endovascular approach including thrombus aspiration, catheter thrombolysis, and percutaneous transluminal angioplasty (PTA) to treat acute and subacute occlusions of native leg arteries.

Materials and methods: Retrospective evaluation of the effectiveness and safety of this catheter therapy in 89 consecutive patients (93 legs) in a single centre.

Results: Treatment was initially successful in 90% of legs. Mortality at 30 days was 8%, and at 12 months 19%. Amputation-free survival at 12 months was 78%. Aspiration alone was sufficient in 31% of cases, urokinase (mean dose 112 500+/-55 900 IU) was used in 22%, PTA was added in 69%. There was no major bleeding except for one false aneurysm treated by ultrasound-guided compression. Secondary interventions within 12 months were required in 30% of cases (14 endovascular, 16 open surgical procedures).

Conclusions: Catheter thrombus aspiration in combination with thrombolysis and/or PTA is highly effective. Only in a minority of patients are thrombolytics in modest doses necessary, and serious bleeding complications are rare. We recommend this procedure as first-line treatment for acute or subacute infrainguinal arterial occlusions.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Angiography
  • Angioplasty, Balloon / methods*
  • Arterial Occlusive Diseases / diagnostic imaging
  • Arterial Occlusive Diseases / mortality
  • Arterial Occlusive Diseases / therapy*
  • Arteries
  • Combined Modality Therapy
  • Female
  • Humans
  • Leg / blood supply*
  • Male
  • Middle Aged
  • Suction
  • Survival Rate
  • Thrombectomy / methods*
  • Thrombolytic Therapy / methods*
  • Thrombosis / diagnostic imaging
  • Thrombosis / mortality
  • Thrombosis / therapy*