Catheter-directed thrombolysis for acute upper extremity ischemia.
| Autor: | Schrijver AM; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands - a.m.schrijver-5@umcutrecht.nl., De Borst GJ, Van Herwaarden JA, Vonken EJ, Moll FL, Vos JA, De Vries JP |
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| Jazyk: | angličtina |
| Zdroj: | The Journal of cardiovascular surgery [J Cardiovasc Surg (Torino)] 2015 Jun; Vol. 56 (3), pp. 433-9. |
| Abstrakt: | Aim: Acute nontraumatic upper extremity ischemia has significant chronic disability when not treated adequately and timely. As surgical treatment can be challenging, this study evaluates catheter-directed thrombolysis as first-line treatment for acute upper extremity ischemia. Methods: Between January 2006 and December 2010, 28 patients (22 women; mean age, 63±16 years) underwent catheter-directed thrombolysis for acute upper extremity ischemia, Rutherford class I or IIa. Proximal extent of the occlusion was in the subclavian (32%), axillary (7%), brachial (25%) and forearm arteries (36%). Median occlusion length was 18 cm (range, 12-43). Causes were embolus (14%), thrombus (39%), thoracic outlet syndrome (14%), paraneoplastic (4%), or unknown (29%). Results: Technical success was 96%, radiologic success (>95% clot lysis) 61%, and clinical success 68%. Median duration of thrombolysis was 24 hours (range, 18-96). Of the 11 radiologically unsuccessful patients (39%), five were treated conservatively and six underwent surgical intervention. In-hospital amputation-rate was 7%. Four complications occurred: embolization to the lower extremity, a transient ischemic attack, a subcapsular splenic hematoma and a pseudoaneurysm. Cumulative amputation-free survival at six months was 93%, standard error (SE) 4.87 and at one year 88%, SE 6.50. Conclusion: These results show that catheter-directed thrombolysis is effective in over 60% of patients as first-line treatment of extensive acute upper extremity ischemia and can prevent surgical intervention in these patients. |
| Databáze: | MEDLINE |
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