Outcome after preoperative or intraoperative use of intra-arterial urokinase thrombolysis for acute popliteal artery thrombosis and leg ischemia.

Abstract

OBJECTIVES:

To evaluate the outcome of acute popliteal artery aneurysm (PAA) thrombosis and leg ischemia after preoperative or intraoperative use of intra-arterial urokinase thrombolysis.

MATERIALS AND METHODS:

From 2000 to 2009, 86 patients with acute leg ischemia (Rutherford grade IB to IIA) from PAA thrombosis were treated by immediate surgery including intraoperative thrombolysis (group A: 47 cases) or preoperative thrombolysis (group B: 39 cases) followed by acute (<24 hours) or elective surgery. Chi-square tests for categorical data and time to event provided two-sided p values with a level of significance at 0.05 and all confidence intervals (CIs) at the 95% level.

RESULTS:

The mean follow-up was 45 months. The 2-year primary patency was 61.7% (29/47) for group A and 43.6% (17/39) for group B (hazard ratio [HR] 1.85; 95% CI: 0.96 to 3.54; p = 0.06). The 2-year secondary patency was 70.2% (33/47) for group A and 53% (21/39) for group B (HR 1.86; 95% CI: 0.91 to 3.81; p = 0.08). One-month amputation rate was 18% in group A and 29% in group B (p < 0.001), and 12-month amputation rate was 19% (9/47) in group A and 44% (17/39) in B (p = 0.05). In group A, 28% of patients required fasciotomy and in group B, 59% (p < 0.05). Effective thrombolysis allowed 82% limb salvage patency in group B. No systemic or locoregional complications during thrombolysis were recorded, but four cases of worsening ischemia were recorded.

CONCLUSION:

Our results suggest that the immediate surgery with intraoperative thrombolysis improved the outcome of patients with acute leg ischemia due to PAA thrombosis in terms of limb salvage.

• Authors: Roberto Gabrielli, Maria Sofia Rosati, Alessandro Carra, Silvio Vitale, Andrea Siani
• Journal: The Thoracic and cardiovascular surgeon (Thorac Cardiovasc Surg) Vol. 63 Issue 2 Pg. 164-7 (Mar 2015) ISSN: 1439-1902 [Electronic] Germany
• PMID: 24911902 (Publication Type: Comparative Study, Journal Article)
• Copyright: Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Fibrinolytic Agents
• Urokinase-Type Plasminogen Activator

Topics

• Aged
• Amputation, Surgical
• Aneurysm (diagnosis, physiopathology, therapy)
• Blood Vessel Prosthesis Implantation (adverse effects)
• Chi-Square Distribution
• Combined Modality Therapy
• Female
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Humans
• Infusions, Intra-Arterial
• Intraoperative Care
• Ischemia (diagnosis, physiopathology, therapy)
• Limb Salvage
• Lower Extremity (blood supply)
• Male
• Middle Aged
• Popliteal Artery (physiopathology)
• Preoperative Care
• Reoperation
• Retrospective Studies
• Risk Factors
• Thrombolytic Therapy (adverse effects, methods)
• Thrombosis (diagnosis, physiopathology, therapy)
• Time Factors
• Treatment Outcome
• Urokinase-Type Plasminogen Activator (administration & dosage, adverse effects)
• Vascular Patency