Thrombolysis and endovascular procedures for the treatment of infrainguinal chronic artherial occlusions

Aim. To eval¬u¬ate the effi¬ca¬cy of ¬intra-arte¬ri¬al throm¬bol¬y¬sis and adjunc¬tive endo¬vas¬cu¬lar pro¬ce¬dures for infra¬in¬gui¬nal ¬native ¬artery chron¬ic occlu¬sions, ¬that ¬result in a ¬recent wors¬en¬ing of symp¬toms ¬because of throm¬bo¬sis super¬im¬posed on under¬ly¬ing path¬o¬log¬ic ¬lesions. Methods. Intra-arte¬ri¬al cath¬e¬ter-direct¬ed throm¬bol¬y¬sis ¬with urok¬i¬nase 300000 IU ¬bolus fol¬lowed by 70000 IU /h for 24-48 ¬hours was admin¬is¬tered to 54 ¬patients affect¬ed ¬with low¬er ¬limb ische¬mia. Twenty-¬three ¬patients (25 ¬limbs) pre¬sent¬ed ¬severe clau¬di¬ca¬tio and 31 -patients (34 ¬limbs) crit¬i¬cal leg ische¬mia; sub¬acute (14 ¬days-3 ¬months) symp¬toms ¬were ¬present in 60.9% and 77.4% , respec¬tive¬ly. After suc¬cess¬ful throm¬bol¬y¬sis, endo¬vas¬cu¬lar pro¬ce¬dures (i.e., angio¬plas¬ty, endo¬lu¬mi¬nal stent¬ing, endo¬pros¬the¬sis place¬ment) ¬were per¬formed in 72% and 67.6%, respec¬tive¬ly. In addi¬tion, infra¬in¬gui¬nal autog¬e¬nous ¬vein recon¬struc¬tion was per¬formed in 5 ¬patients ¬with crit¬i¬cal leg ische¬mia. Results. Initial clin¬i¬cal improve¬ment was ¬seen in 76% of 25 extrem¬ities in ¬group I, ¬with a 30-day pri¬mary paten¬cy and ¬relief of clau¬di¬ca¬tio in 68%. Arterial rec¬a¬nal¬iza¬tion was ¬achieved in 23 (67.6%) and res¬to¬ra¬tion of ¬flow in tar¬get ves¬sels for sub¬se¬quent ¬bypass in 5 (14.7%) of 34 extrem¬ities in ¬group II. The 30-day ¬limb-sal¬vage was 73.5%; ¬limb ¬loss includ¬ed 2 ampu¬ta¬tions (5.9%) as a ¬result of infec¬tion and/or necro¬sis in dia¬bet¬ic ¬patients, ¬despite ana¬tom¬ic paten¬cy at the endo¬vas¬cu¬lar pro¬ce¬dure ¬site. Relief of ische¬mia was ¬achieved in 56% of clau¬di¬cants (¬mean fol¬low-up, 42 ¬months) and ¬limb sal¬vage in 52.9% of ¬patients ¬with crit¬i¬cal ische¬mia (¬mean fol¬low-up, 36 ¬months). Conclusion. Thrombolysis and adjunc¬tive endo¬vas¬cu¬lar pro¬ce¬dures are an accept¬able ther¬a¬peu¬tic ¬option for the treat¬ment of wors¬en¬ing man¬i¬fes¬ta¬tions of chron¬ic occlu¬sive dis¬ease of the femor¬o¬pop¬li¬teal arte¬ri¬al seg¬ment.