Contemporary trends and outcomes of thrombolytic therapy for acute lower extremity ischemia
| Autor: | Todd R. Vogel, Viktor Y. Dombrovskiy, Jonathan Bath, Ryan J. Kim |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Time Factors Adolescent Databases Factual medicine.medical_treatment Clinical Decision-Making 030204 cardiovascular system & hematology Amputation Surgical Young Adult 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Ischemia Risk Factors Intervention (counseling) medicine Humans Thrombolytic Therapy Radiology Nuclear Medicine and imaging Practice Patterns Physicians' Lower extremity ischemia Aged Aged 80 and over business.industry Patient Selection Endovascular Procedures General Medicine Thrombolysis Middle Aged Combined Modality Therapy Conversion to Open Surgery Limb ischemia United States Treatment Outcome Lower Extremity Anesthesia Acute Disease Female Surgery Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Vascular. 27:71-77 |
| ISSN: | 1708-539X 1708-5381 |
| DOI: | 10.1177/1708538118797782 |
| Popis: | Objective Acute limb ischemia is a common vascular emergency requiring immediate intervention. Thrombolysis has been widely utilized for acute limb ischemia; the purpose of this study is to analyze contemporary trends, outcomes and complications of thrombolysis for acute limb ischemia. Methods Patients were identified from the Nationwide Inpatient Sample (2003–2013) using ICD-9. Patients undergoing emergency thrombolysis for acute limb ischemia were evaluated. Three groups were analyzed: thrombolysis alone, thrombolysis and endovascular procedure (T+ENDO), and failed thrombolysis requiring open surgery (T+OPEN). Results A total of 162,240 patients with acute limb ischemia were estimated: 33,615 patients (20.7%) underwent thrombolysis as the initial treatment. Mean age was 66.2 ± 34.9 years with 54% male. The utilization of thrombolysis increased significantly during the study period (16.8–24.2%, p Conclusion Thrombolysis remains an effective treatment for acute limb ischemia with increased utilization over time. There was a significant increase in thrombolysis and endovascular procedure leading to improved outcomes. Thrombolysis alone carried the highest mortality and stroke rate, with T+OPEN associated with the highest amputation and complications. Although thrombolysis is effective, 25% of patients required an open procedure suggesting that patient selection for thrombolysis first instead of open surgery continues to be a clinical challenge. |
| Databáze: | OpenAIRE |
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