Success of thrombolysis as a predictor of outcome in acute thrombosis of popliteal aneurysms.

Abstract

PURPOSE:

Acute limb ischemia after thrombosis of a popliteal aneurysm is a distinct and limb-threatening entity. Preoperative intra-arterial thrombolysis may improve the outcome in this challenging situation. This study retrospectively analyzed a consecutive series of patients treated with preoperative thrombolysis and subsequent revascularization.

METHODS:

Thirteen patients with acute limb ischemia caused by thrombosis of a popliteal aneurysm underwent catheter-directed intra-arterial thrombolysis with urokinase and subsequent vascular reconstruction. The angiographic and clinical outcome was analyzed and compared with that in the literature.

RESULTS:

Complete aneurysm thrombosis with absence of runoff was documented in 12 cases. Thrombolysis restored perfusion with patency of the popliteal artery and a one- or two-vessel runoff in 77% of cases (10/13). Early cumulative graft patency and limb salvage rates were 68% and 83%, respectively, with an ankle/brachial index of 0.8 +/- 0.2. Lytic failure followed by attempts at bypass grafting was present in three patients (23%) and resulted in above-knee amputation. Severe rhabdomyolysis and fatal pulmonary embolism were responsible for a 15% early mortality rate.

CONCLUSION:

Preoperative thrombolysis followed by bypass grafting is a valid treatment option for patients who can withstand an additional period of ischemia that does not require immediate revascularization and intraoperative lysis. Lytic failure identifies patients with a highly compromised runoff who are probably best treated by means of subsequent amputation, without any attempts at bypass grafting.

• Authors: Bettina Marty, Stephan Wicky, Hans-Beat Ris, Xavier Mueller, Adam Fischer, Daniel Hayoz, Ludwig Karl von Segesser
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 35 Issue 3 Pg. 487-93 (Mar 2002) ISSN: 0741-5214 [Print] United States
• PMID: 11877696 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Urokinase-Type Plasminogen Activator

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Aneurysm (complications, drug therapy)
• Extremities (blood supply, diagnostic imaging, pathology)
• Female
• Follow-Up Studies
• Humans
• Male
• Popliteal Artery (diagnostic imaging, pathology)
• Predictive Value of Tests
• Radiography
• Reoperation
• Retrospective Studies
• Switzerland (epidemiology)
• Thrombolytic Therapy (adverse effects)
• Thrombosis (complications, drug therapy)
• Time Factors
• Treatment Outcome
• Urokinase-Type Plasminogen Activator (therapeutic use)
• Vascular Patency (drug effects)