Article: article from journal or magazin.
Success of thrombolysis as a predictor of outcome in acute thrombosis of popliteal aneurysms.
Journal of Vascular Surgery
Publication types: Comparative Study ; Journal Article
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.
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
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