Thrombolytic Therapy of Acute Peripheral Arterial Occlusions of Limb Arteries

Česká verzia

Authors: J. Buček; R. Staffa; B. Vojtíšek ^*
Authors place of work: II. chirurgická klinika FN u sv. Anny v Brně a LF Masarykovy Univerzity, Brno, přednosta: prof. MUDr. Robert Staffa, Ph. D. ; KZM FN u sv. Anny v Brně a LF Masarykovy Univerzity, Brno, přednosta: MUDr. Jiří Vaníček, Ph. D. ^*
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 9, s. 512-516.
Category: Monotematický speciál - Původní práce

Summary

Introduction:
Thrombolytic therapy is a method of solution of thrombotic arterial occlusions of limbs using the physiological process of fibrinolysis. The severity of limb ischemia is the crucial for therapy. If immediate recanalization of arterial system is necessary than primarily surgical teratment is chosen.

The Method:
The arterial closures in infrainguinal localization are indicated for thrombolysis. Especially occlusions of crural vessels and the closures of previous vascular reconstruction (bypass) are indicated. The methods of local intra-arterial thrombolysis with application of recombinant tissue plasminogen activator, (rt-PA Actilyse) through catheter introduced into the level of thrombotic occlusion by Seldinger’s Metod are used in our department.

Results:
The authors present retrospectively analyzed set of 51 patients (12 women and 39 men aged 33 to 85 years) with acute arterial occlusion solved with thrombolytic therapy in the period 02/2007 – 03/2010. Complete recanalization was achieved in 43 cases (patients) (84%), high amputation of limbs was performed in 3 cases (5.9%).

Key words:
thrombolysis – rt-PA – acute thrombosis – acute limb ischemia

Zdroje

1. Sikri, N., Bardia, A. A history of streptokinase use in acute myocardial infarction. Tex. Heart Inst. J., 2007; 34(3): 318–327.

2. Working Party on Thrombolysis in the Management of Limb Ischemia. Thrombolysis in the management of lower limb peripheral arterial occlusion-a consensus document. Working Party on Thrombolysis in the Management of Limb Ischemia. Am. J. Cardiol., Jan, 15, 1998; 81(2): 207–218.

3. Hall, T. B., Mason, M., Belli, A. M. Trombolysis in the peripheral vascular system. Eur. Radiol., 2001; 11: 439–445.

4. Kessel D. O., Berridge, D. C., Robertson, I. Infusion techniques for peripheral arterial thrombolysis. Cochrane Database Syst. Rev., 2004, (1).

5. STILE Investigators. Results of prospective randomised trial evaluating surgery versus trombolysis for ischemia of the lower extremity. The STILE Trial. Annals of Surgery, 1994; 220: 251–268.

6. Dawson, K., Armon, A., Braithwaite, B., et al. Stroke during intra-arterial thrombolysis: a survey of experience in the UK. Br. J. Surg., 1996; 83: 568.

7. Semba, C. P., Murphy, T. P., Bakal, C. W., et al. Thrombolytic therapy with use of alteplase (rt-PA) in peripheral arterial occlusive disease: review of the clinical literature. The Advisory Panel. J. Vasc. Interv. Radiol. Feb., 2000; 11: 149–161.

8. Costantini, V., Lenti, M. Treatment of acute occlusion of peripheral arteries. Thrombosis Research, 106(2002): 285–294.

9. Braithwaite, B. D., et al. Peripheral thrombolysis for acute-onset claudication. Br. J. Surg., 1999; 86: 800–804.

10. Korn, P., Khilmani, N. M., Fellers, J. C., et al. Trombolysis for native arterial occlusion of the košer extremities: Clinical outcome and cost. J. BASF Surg., 2001; 33: 1148–1157.