When is thrombolysis for acute lower limb ischemia worthwhile?

Eur J Vasc Endovasc Surg. 2009 Feb;37(2):206-12. doi: 10.1016/j.ejvs.2008.11.010. Epub 2008 Dec 2.

Abstract

Objectives: To find variables associated with outcome following thrombolytic treatment for acute lower limb ischemia.

Design: Re-analysis of a prospective multicentre study.

Material and methods: One hundred and twenty-one patients with acute lower limb ischemia previously included in a randomised study comparing high- with low-dose thrombolysis were re-analysed ignoring the mode of lytic treatment. All possibly predictive variables were subjected to multivariate analyses to find associations with outcome.

Results: Previous successful thrombolysis, ankle-brachial index over 0.33, absence of motor dysfunction, presence of cardiac arrhythmia, and lysis of a vascular graft were all associated with successful thrombolysis (p=0.003). Previous thrombolysis, age less than 70 years, and ankle-brachial index over 0.33 were all perfect predictors of absence of life-threatening complications or death. Successful lysis, age<70, and lysis of a native artery as opposed to a vascular graft were all associated with clinical success (preserved patency, limb, and life) after one year (p=0.002).

Conclusions: Previous thrombolysis, age under 70 years, and non-severe ischemia predict successful thrombolysis free from severe complications. Successful thrombolysis is strongly predictive of amputation-free survival with vascular patency for at least one year. Occluded grafts could often be reopened, but long-term outcome is better after thrombolysis of native arteries.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Amputation
  • Ankle / blood supply
  • Blood Pressure
  • Brachial Artery / physiopathology
  • Female
  • Humans
  • Ischemia / drug therapy*
  • Ischemia / physiopathology
  • Ischemia / surgery
  • Logistic Models
  • Lower Extremity / blood supply*
  • Male
  • Middle Aged
  • Patient Selection*
  • Prospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sweden
  • Thrombolytic Therapy* / adverse effects
  • Treatment Failure
  • Treatment Outcome
  • Vascular Patency
  • Vascular Surgical Procedures