CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.455 |
Resumo: | Introduction: Over the past few decades management options of the acute limb ischaemia (ALI) have changed. Nowadays, catheter direct thrombolysis (CDT) is commonly used as an alternative to surgery in immediate management of the ALI and may offer certain advantages over surgery in appropriately selected patients. Objective: To evaluate CDT data for the treatment of acute ischaemia in lower extremity in different aetiologies. Materials and methods: All consecutive patients who underwent CDT for acute limb ischaemia in our vascular surgery department, between 1 January 2011 to 31 August 2017 were identified and reviewed. Outcome measures included primary patency at 30 days and one year, haemorrhagic complications, major amputation and mortality. Results: In total, 128 limbs from 106 patients were included. The median follow-up was 14 months [range: 6–31 months]. The aetiologies of ischaemia included in the study were native artery thrombosis, PTFE and GSV bypass thrombosis, intra-stent thrombosis, popliteal aneurysm and entrapment thrombosis and arterial embolism. The Stages of ALI according to the Rutherford classification were 12,5% in class I, 77,3% in class IIa and 10,2% in class IIb. Primary patency rates were 71.3% and 47.8% at one and three years, respectively. The requirement for re-intervention was 27.6% in the native artery thrombosis group, 65.2% in the PTFE graft thrombosis group, and 18.2% in the intra-stent thrombosis group. No re-interventions were verified for popliteal aneurysm or arterial embolism aetiologies. The overall amputation free survival was 83.3% at 27 months, and the cumulative incidence of death was 10.1% at 32 months. Complications occurred in 40 interventions (31.3%); the majority comprised minor bleeding from the access site, and one death due to haemorrhagic stroke. Conclusions: CDT although associated with an increased risk of bleeding complications, it is a feasible and safe therapy, with clinical outcomes that may reduce the need for open surgical treatment in many patients. Our findings support this therapeutic approach as a valid option in ALI, in different aetiologies. |
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CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIESTROMBÓLISE DIRIGIDA POR CATETER NA ISQUEMIA AGUDA DOS MEMBROS INFERIORES EM DIFERENTES ETIOLOGIAScatheter direct thrombolysisacute limb ischaemiaIntroduction: Over the past few decades management options of the acute limb ischaemia (ALI) have changed. Nowadays, catheter direct thrombolysis (CDT) is commonly used as an alternative to surgery in immediate management of the ALI and may offer certain advantages over surgery in appropriately selected patients. Objective: To evaluate CDT data for the treatment of acute ischaemia in lower extremity in different aetiologies. Materials and methods: All consecutive patients who underwent CDT for acute limb ischaemia in our vascular surgery department, between 1 January 2011 to 31 August 2017 were identified and reviewed. Outcome measures included primary patency at 30 days and one year, haemorrhagic complications, major amputation and mortality. Results: In total, 128 limbs from 106 patients were included. The median follow-up was 14 months [range: 6–31 months]. The aetiologies of ischaemia included in the study were native artery thrombosis, PTFE and GSV bypass thrombosis, intra-stent thrombosis, popliteal aneurysm and entrapment thrombosis and arterial embolism. The Stages of ALI according to the Rutherford classification were 12,5% in class I, 77,3% in class IIa and 10,2% in class IIb. Primary patency rates were 71.3% and 47.8% at one and three years, respectively. The requirement for re-intervention was 27.6% in the native artery thrombosis group, 65.2% in the PTFE graft thrombosis group, and 18.2% in the intra-stent thrombosis group. No re-interventions were verified for popliteal aneurysm or arterial embolism aetiologies. The overall amputation free survival was 83.3% at 27 months, and the cumulative incidence of death was 10.1% at 32 months. Complications occurred in 40 interventions (31.3%); the majority comprised minor bleeding from the access site, and one death due to haemorrhagic stroke. Conclusions: CDT although associated with an increased risk of bleeding complications, it is a feasible and safe therapy, with clinical outcomes that may reduce the need for open surgical treatment in many patients. Our findings support this therapeutic approach as a valid option in ALI, in different aetiologies.Introdução: Ao longo das últimas décadas houve uma evolução nas opções de tratamento da isquemia aguda de membro (IAM). Hoje em dia, a trombólise dirigida por cateter (TDC) é por vezes utilizada como alternativa à cirurgia no tratamento da IAM e pode oferecer algumas vantagens em relação à cirurgia convencional em pacientes devidamente seleccionados. Objectivo: Avaliar os dados relativos à TDC para o tratamento da isquemia aguda de membro em diferentes etiologias. Materiais e métodos: Foram consecutivamente analisados todos os pacientes submetidos a TDC na isquemia aguda de membro no nosso serviço de cirurgia vascular, entre 1 de Janeiro de 2011 e 31 de Agosto de 2017. Os resultados incluíram a patência primária aos 30 dias e um ano, complicações hemorrágicas, amputação major e mortalidade. Resultados: No total foram incluídos 128 membros de 106 pacientes. O seguimento mediano foi de 14 meses [6–31 meses]. As etiologias de isquemia incluídas no estudo foram trombose de artérias nativas, trombose de bypass PTFE ou VGS, trombose intra-stent, trombose de aneurisma ou entrapment poplíteo e embolia arterial. De acordo com a classificação de Rutherford na IAM foram observados no grau I 12,5%, grau IIa 77,3% e grau IIb 10,2%. As taxas de patência primária foram de 72,8% e 47,8% a um e três anos, respectivamente. A reintervenção foi de 27,6% no grupo da trombose de artéria nativa, 65,2% no grupo da trombose de bypass de PTFE, e 18,2% no grupo da trombose intra-stent. Não foram verificadas reintervenções para os grupos de aneurisma poplíteo ou embolia arterial. A sobrevida livre de amputação foi de 83,3% aos 27 meses, e a incidência cumulativa de morte foi de 10,1% aos 32 meses. Observaram-se complicações em 40 procedimentos (31,3%); a maioria hemorragia minor do local de acesso e uma morte devido a acidente vascular cerebral hemorrágico. Conclusão: A TDC embora associada a um risco acrescido de complicações hemorrágicas, é considerada um tratamento seguro e com resultados que podem reduzir a necessidade de tratamento cirúrgico convencional em doentes selecio- nados. O nosso estudo vem reforçar o uso desta terapêutica como uma opção válida na IAM em diferentes etiologias.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2022-03-02T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.455oai:ojs.acvjournal.com:article/455Angiologia e Cirurgia Vascular; Vol. 17 No. 4 (2021): December; 299-304Angiologia e Cirurgia Vascular; Vol. 17 N.º 4 (2021): Dezembro; 299-3042183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/455https://doi.org/10.48750/acv.455http://acvjournal.com/index.php/acv/article/view/455/270Copyright (c) 2022 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessSoares, TiagoDias, PauloSampaio, SérgioTeixeira, José2022-05-23T15:10:14Zoai:ojs.acvjournal.com:article/455Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:46.428577Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES TROMBÓLISE DIRIGIDA POR CATETER NA ISQUEMIA AGUDA DOS MEMBROS INFERIORES EM DIFERENTES ETIOLOGIAS |
title |
CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES |
spellingShingle |
CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES Soares, Tiago catheter direct thrombolysis acute limb ischaemia |
title_short |
CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES |
title_full |
CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES |
title_fullStr |
CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES |
title_full_unstemmed |
CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES |
title_sort |
CATHETER DIRECT THROMBOLYSIS IN ACUTE LOWER LIMB ISCHAEMIA IN DIFFERENT AETIOLOGIES |
author |
Soares, Tiago |
author_facet |
Soares, Tiago Dias, Paulo Sampaio, Sérgio Teixeira, José |
author_role |
author |
author2 |
Dias, Paulo Sampaio, Sérgio Teixeira, José |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Soares, Tiago Dias, Paulo Sampaio, Sérgio Teixeira, José |
dc.subject.por.fl_str_mv |
catheter direct thrombolysis acute limb ischaemia |
topic |
catheter direct thrombolysis acute limb ischaemia |
description |
Introduction: Over the past few decades management options of the acute limb ischaemia (ALI) have changed. Nowadays, catheter direct thrombolysis (CDT) is commonly used as an alternative to surgery in immediate management of the ALI and may offer certain advantages over surgery in appropriately selected patients. Objective: To evaluate CDT data for the treatment of acute ischaemia in lower extremity in different aetiologies. Materials and methods: All consecutive patients who underwent CDT for acute limb ischaemia in our vascular surgery department, between 1 January 2011 to 31 August 2017 were identified and reviewed. Outcome measures included primary patency at 30 days and one year, haemorrhagic complications, major amputation and mortality. Results: In total, 128 limbs from 106 patients were included. The median follow-up was 14 months [range: 6–31 months]. The aetiologies of ischaemia included in the study were native artery thrombosis, PTFE and GSV bypass thrombosis, intra-stent thrombosis, popliteal aneurysm and entrapment thrombosis and arterial embolism. The Stages of ALI according to the Rutherford classification were 12,5% in class I, 77,3% in class IIa and 10,2% in class IIb. Primary patency rates were 71.3% and 47.8% at one and three years, respectively. The requirement for re-intervention was 27.6% in the native artery thrombosis group, 65.2% in the PTFE graft thrombosis group, and 18.2% in the intra-stent thrombosis group. No re-interventions were verified for popliteal aneurysm or arterial embolism aetiologies. The overall amputation free survival was 83.3% at 27 months, and the cumulative incidence of death was 10.1% at 32 months. Complications occurred in 40 interventions (31.3%); the majority comprised minor bleeding from the access site, and one death due to haemorrhagic stroke. Conclusions: CDT although associated with an increased risk of bleeding complications, it is a feasible and safe therapy, with clinical outcomes that may reduce the need for open surgical treatment in many patients. Our findings support this therapeutic approach as a valid option in ALI, in different aetiologies. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-03-02T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48750/acv.455 oai:ojs.acvjournal.com:article/455 |
url |
https://doi.org/10.48750/acv.455 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/455 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
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http://acvjournal.com/index.php/acv/article/view/455 https://doi.org/10.48750/acv.455 http://acvjournal.com/index.php/acv/article/view/455/270 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2022 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2022 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular; Vol. 17 No. 4 (2021): December; 299-304 Angiologia e Cirurgia Vascular; Vol. 17 N.º 4 (2021): Dezembro; 299-304 2183-0096 1646-706X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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