LOCAL INTRAARTERIAL THROMBOLYSIS IN LIMB-THREATENING ISCHEMIA

The purpose of this study was to determine the angiographic and clinic al success rate and the immediate limb salvage and mortality rate afte r intra-arterial thrombolysis in limb-threatening ischaemia. A retrosp ective study of 66 patients treated with intra-arterial thrombolysis f or 71 episodes of limb-threatening ischaemia was carried out. Immediat e angiographic recanalisation rate, pre- and post-treatment ankle-brac hial index (ABI) and clinical stage were established. Major amputation s and deaths were recorded. The immediate primary angiographic recanal isation was complete in 25 cases and partial in 20 cases. Combined com plete plus partial recanalisation rate was thus 63.4 % (45/71). The ov erall mean ABI after treatment was significantly higher than before tr eatment (0.35 versus 0.68), excluding patients undergoing amputation. Clinical improvement was achieved in 59.2 % of cases for one month aft er treatment. The amputation rate was 18.3 % during the first month an d 29.6 % during the median follow-up of 16 weeks. The mortality rates were 6.1 % and 33.3 % respectively. Despite a high mortality the compl ications of thrombolysis were few emphasizing the relative safety of t his method in treating limb threatening ischaemia. Furthermore, thromb olysis may identify the underlying pathology, which can be corrected b y additional surgery or interventional procedure.