Percutaneous catheter thrombus aspiration for acute or subacute arterial occlusion of the legs: How much thrombolysis is needed?

Objective: to evaluate the role of a combined percutaneous endovascular app roach including thrombus aspiration, catheter thrombolysis, and percutaneou s transluminal angioplasty (PTA) to treat acute and subacute occlusions of native leg arteries. Materials and methods: retrospective evaluation of the effectiveness and sa fety of this catheter therapy in 89 consecutive patients (93 legs) in a sin gle centre. Results: treatment was initially successful in 90% of legs. Mortality at 30 days was 8%, and at 12 months 19%. Amputation-free survival at 12 months w as 78%. Aspiration alone was sufficient in 31% of cases, urokinase (mean do se 112 500 +/- 55 900 IU) was used in 22%, PTA was added in 69%. There was no major bleeding except for one false aneurysm treated by ultrasound-guide d compression. Secondary interventions within 12 months were required in 30 % of cases (14 endovascular, 16 open surgical procedures). Conclusions: catheter thrombus aspiration in combustion with thrombolysis a nd/or PTA is highly effective. Only in a minority of patients are thromboly tics in modest doses necessary, and serious bleeding complications are rare . We recommend this procedure as first-line treatment for acute or subacute infrainguinal arterial occlusions.