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

Details

Serval ID
serval:BIB_F02E338A7D38
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Success of thrombolysis as a predictor of outcome in acute thrombosis of popliteal aneurysms.
Journal
Journal of Vascular Surgery
Author(s)
Marty B., Wicky S., Ris H.B., Mueller X., Fischer A., Hayoz D., von Segesser L.K.
ISSN
0741-5214
Publication state
Published
Issued date
2002
Peer-reviewed
Oui
Volume
35
Number
3
Pages
487-493
Language
english
Notes
Publication types: Comparative Study ; Journal Article
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.
Keywords
Acute Disease, Aged, Aged, 80 and over, Aneurysm/complications, Aneurysm/drug therapy, Extremities/blood supply, Extremities/pathology, Female, Follow-Up Studies, Humans, Male, Popliteal Artery/pathology, Popliteal Artery/radiography, Predictive Value of Tests, Reoperation, Retrospective Studies, Switzerland/epidemiology, Thrombolytic Therapy/adverse effects, Thrombosis/complications, Thrombosis/drug therapy, Time Factors, Treatment Outcome, Urokinase-Type Plasminogen Activator/therapeutic use, Vascular Patency/drug effects
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2008 16:38
Last modification date
20/08/2019 16:18
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