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

Détails

ID Serval
serval:BIB_F02E338A7D38
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Success of thrombolysis as a predictor of outcome in acute thrombosis of popliteal aneurysms.
Périodique
Journal of Vascular Surgery
Auteur(s)
Marty B., Wicky S., Ris H.B., Mueller X., Fischer A., Hayoz D., von Segesser L.K.
ISSN
0741-5214
Statut éditorial
Publié
Date de publication
2002
Peer-reviewed
Oui
Volume
35
Numéro
3
Pages
487-493
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article
Résumé
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.
Mots-clé
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
Oui
Création de la notice
17/01/2008 17:38
Dernière modification de la notice
09/05/2019 3:15
Données d'usage