COMPUTERIZED ANGIOGRAPHIC ANALYSIS OF THE OUTCOME OF PERIPHERAL THROMBOLYSIS

BACKGROUND: Catheter-directed peripheral thrombolysis is used increasi ngly for the management of acute limb ischemia. The comparison of diff erent agents and techniques has proven difficult because of the variat ions in patient presentation, vessel involvement, and treatment method s. METHODS: A computerized database in which angiographic information is stored on computerized arterial maps has been designed to record de tails of thrombolysis. RESULTS: A total of 201 patients who presented with rest pain were recorded on the database, and their angiograms wer e analyzed. There were 123 native-vessel and 78 graft occlusions. imme diate success of lysis and 30-day outcome were not dependent on the si te of the occlusion. If an underlying stenosis was revealed, limb salv age rates were significantly greater than when none was found (82% ver sus 58%, P < 0.01). The presence of at least 1 run-off vessel increase d limb salvage rates by 30% (P < 0.001). If more than 5 arterial segme nts were occluded on the prelysis angiogram, limb salvage was worse th an if there were fewer than 5 (57% versus 85%, P < 0.0001). For grafts , less than 5 segments of occlusion led to limb salvage rates of 90%, and more than 5 segments of occlusion led to rates of 72% (P = 0.07). CONCLUSIONS: This simple and user-friendly system of computerized angi ographic analysis will enable detailed examination of thrombolytic pra ctice and assist in the prediction of success.