ACUTE LIMB DETERIORATION DURING INTRAARTERIAL THROMBOLYSIS

Approximately 12 per cent of limbs undergoing intra-arterial thromboly sis (IAT) develop distal embolism or extension of thrombus during the procedure. These are usually of little clinical consequence and can be treated by increasing the rate of administration of the lytic agent. However, in some patients the clinical condition of the limb deteriora tes rapidly. In an attempt to define the incidence of acute limb deter ioration during IAT, information was collected from five centres in th e UK with experience of the technique. A total of 866 treatments were recorded, with 20 limbs (2.3 per cent) undergoing acute deterioration. This complication was more common during the treatment of thrombosed popliteal aneurysm than during that of emboli or thrombosed atheromato us arteries or grafts (P < 0.001). The amputation rate associated with the complication was high, and operative intervention provided better results than continuation of lysis.