CLINICAL AND ANGIOGRAPHIC SELECTION FACTORS FOR THROMBOLYSIS AS INITIAL THERAPY FOR ACUTE LOWER-LIMB ISCHEMIA

The purpose of this study was to determine whether angiographic patter ns correlate with the clinical severity of acute lower limb ischemia ( ALLI) and with the outcome of treatment with percutaneous intraarteria l thrombolysis (PIAT), A retrospective analysis was conducted of angio grams and case records of 186 consecutive PIAT infusions in 160 patien ts with ALLI, The number of segments of occlusions; associated stenose s of inflow, outflow, and collateral vessels; and the demonstration of patent distal vessels were correlated with severity of ischemia and o utcome of PIAT, Occlusions requiring now to traverse one collateral be d to supply patent distal vessels (angiographic category I) correlated with the ''viable'' clinical classification of ALLI. Those requiring blood to flow through two contiguous collateral beds to supply patent distal vessels (category II) correlated with the ''threatened'' clinic al classification, Occlusions with distal propagation that occluded th e distal vascular bed (category III) correlated with the ''irreversibl e'' clinical. category, Rates-at 30 days for patency amputation, and m ortality were as follows for category I: 100%, 0%, and 0%; category II : 90%, 8.6%, and 0.7%; and category III: 55%, 19%, and 5%, respectivel y, Angiographic patterns correlate well with clinical severity of isch emia and predict the outcome from PIAT as initial therapy of ALLI, Amp utation and mortality rates are less than those reported for emergency surgical treatment of ALLI.