Possibilities of endovascular treatment of acute limb ischaemia

Česká verzia

Authors: J. Krátký ¹; D. Kučera ^1,2; M. Válka ¹; J. Kozák ¹; D. Maděřič ¹; V. Jetmar ¹; J. Bezecný ¹
Authors place of work: Vaskulární centrum, Vítkovická nemocnice a. s., Ostrava ¹; II. interní klinika kardiologie a angiologie 1. LF UK a VFN v Praze ²
Published in the journal: Kardiol Rev Int Med 2016, 18(3): 179-186

Summary

Acute limb ischaemia (ALI) is a serious health complication that threatens limb viability if no adequate therapy is provided. If the patient is not sufficiently treated, an amputation is required in 5% to 30% of cases, and mortality is up to 18%. Circulatory disorders of the lower extremities are either caused by thrombosis and/or by embolisation in the arterial trunk of the lower limb arteries. Most ALI cases are caused by a peripheral embolisation of the intracardiac thrombus, usually as a result of atrial fibrillation. Clinical manifestations depend on the location and the extent of the arterial closure. The patient’s clinical condition, physical examination and diagnosis through imaging of the affected limb are crucial for further treatment strategy. At present, we can choose between endovascular techniques, surgical revascularisation or anticoagulant therapy. This article focuses on the possibility of endovascular recanalisation of acute arterial closures using pharmacological or mechanical endovascular systems. Pharmacological endovascular treatment consists of the application of recombinant tissue plasminogen activator directly into the closure using special perforated thrombolytic catheters. A mechanical endovascular recanalisation system is achieved using the Rotarex system. This article also presents a group of patients treated with endovascular procedures at the Vascular Centre of the Vítkovice Hospital.

Keywords:
acute limb ischaemia – endovascular recanalisation – local catheter thrombolysis – Rotarex^®

Zdroje

1. Lurie F, Vaidya V, Comerota AJ. Clinical outcomes and cost-effectiveness of initial treatment strategies for nonembolic acute limb ischemia in real-life clinical settings. J Vasc Surg 2015; 61: 138–146. doi: 10.1016/j.jvs.2014.07.086.

2. Malgor RD, Alalahdab F, Elraiyah TA et al. A systematic review of treatment of intermittent claudication in the lower extremities. J Vasc Surg 2015; 61 (3 Suppl): 54S–73S. doi: 10.1016/j.jvs.2014.12.007.

3. Ravari H, Pezeshki Rad M, Bahadori A et al. Comparison of conventional angiographic findings between trauma patients with or without runoff. Bull Emerg Trauma 2014; 2: 72–76.

4. Eliason JL, Wainess RM, Proctor MC et al. A national and single institutional experience in the contemporary treatment of acute lower extremity ischemia. Ann Surg 2003; 238: 382–389. doi: 10.1097/01.sla.0000086663.49670.d1.

5. Earnshaw JJ, Whitman B, Foy C. National Audit of Thrombolysis for Acute Leg Ischemia (NATALI): clinical factors associated with early outcome. J Vasc Surg 2004; 39: 1018–1025. doi: 10.1016/j.jvs.2004.01.019.

6. Karetová D, Staněk F et al. Angiologie pro praxi. 2. rozšířené vyd. Praha: Maxdorf 2007.

7. Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg 2009; 22: 5–9. doi: 10.1053/j.semvascsurg.2008.12.003.

8. Creager MA, Kaufman JA, Conte MS. Clinical practice. Acute limb ischemia. N Engl J Med 2012; 366: 2198–2206. doi: 10.1056/NEJMcp1006054.

9. Acosta S, Kuoppala M. Update on intra-arterial thrombolysis in patients with lower limb ischemia. J Cardiovasc Surg (Torino) 2015; 56: 317–324.

10. Byrne RM, Taha AG, Avgerinos E et al. Contemporary outcomes of endovascular interventions for acute limb ischemia. J Vasc Surg 2014; 59: 988–995. doi: 10.1016/j.jvs.2013.10.054.

11. Grip O, Kuoppala M, Acosta S et al. Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion. Br J Surg 2014; 101: 1105–1112. doi: 10.1002/bjs.9579.

12. Khosla S, Jain P, Manda R et al. Acute and long-term results after intra-arterial thrombolysis of occluded lower extremity bypass grafts using recombinant tissue plasminogen activator for acute limb-threatening ischemia. Am J Ther 2003; 10: 3–6.

13. Leiner T, Kessels AG, Nelemans PJ et al. Peripheral arterial disease: comparison of color duplex US and contrast-enhanced MR angiography for diagnosis. Radiology 2005; 235: 699–708.

14. Favaretto E, Pili C, Amato A et al. Analysis of agreement between duplex ultrasound scanning and arteriography in patients with lower limb artery disease. J. Cardiovasc Med 2007; 8: 337–341.

15. Shareghi S, Gopal A, Gul K et al. Diagnostic accuracy of 64 multidetector computed tomographic angiography in peripheral vascular disease. Catheter Cardiovasc Interv 2010; 75: 23–31. doi: 10.1002/ccd.22228.

16. Tendera M, Aboyans V, Bartelink ML et al. European Stroke Organisation. ESC Committee for Practice Guidelines. ESC guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 2851–2906. doi: 10.1093/eurheartj/ehr211.

17. Wongwanit C, Hahtapornsawan S, Chinsakchai K et al. Catheter-directed thrombolysis for acute limb ischemia caused by native artery occlusion: an experience of a university hospital. J Med Assoc Thai 2013; 96: 661–668.

18. Pascoe H, Robertson D. Catheter-directed thrombolysis for acute limb ischaemia: An audit. Australas Med J 2014; 7: 471–475. doi: 10.4066/AMJ.2014.2065.

19. Zhang F, Zhang H, Luo X et al. Catheter-directed thrombolysis-assisted angioplasty for chronic lower limb ischemia. Ann Vasc Surg 2014; 28: 590–595. doi: 10.1016/j.avsg.2013.05.015.

20. Kearon C, Akl E, Comerota A et al. American College of Chest Physicians. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice Guidelines. Chest 2012; 141 (Suppl 2): e419S–e494S.

21. Alonso-Coello P, Bellmunt S, McGorrian C et al. antithrombotic therapy in peripheral artery disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl 2): e669S–e690S. doi: 10.1378/chest.11-2307.

22. Graor R, Comerota A, Douville Y et al. Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower-extremity-the stile trial. Ann Surg 1994; 220: 251–266.

23. Ouriel K, Veith FJ, Sasahara AA. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med 1998; 338: 1105–1111.

24. Weaver FA, Comerota AJ, Youngblood M et al. Surgical revascularization versus thrombolysis for nonembolic lower extremity native artery occlusions: results of a prospective randomized trial. The STILE Investigators. Surgery versus Thrombolysis for Ischemia of the Lower Extremity. J Vasc Surg 1996; 24: 513–521.

25. Berridge DC, Kessel DO, Robertson I. Surgery versus thrombolysis for initial management of acute limb ischaemia. Cochrane Database Syst Rev 2013; 6: CD002784. doi: 10.1002/14651858.CD002784.pub2.

26. Duc SR, Schoch E, Pfyffer M et al. Recanalization of acute and subacute femoropopliteal artery occlusions with the rotarex catheter: one year follow-up, single center experience. Cardiovasc Intervent Radiol 2005; 28: 603–610.

27. Wissgott C, Kamusella P, Andresen R. Recanalization of acute and subacute venous and synthetic bypass-graft occlusions with a mechanical rotational catheter. Cardiovasc Intervent Radiol 2013; 36: 936–942. doi: 10.1007/s00270-012-0507-9.

28. Zeller T, Frank U, Bürgelin K et al. Langzeitergebnisse nach Rekanalisation akuter und subakuter thrombotischer arterieller Verschlüsse der unteren Extremitäten mit einem Rotations Thrombektomiekatheter. Rofo 2002; 174: 1559–1565.

29. Wissgott C, Kamusella P, Richter A et al. Mechanical rotational thrombectomy for treatment thrombolysis in acute and subacute occlusion of femoropopliteal arteries: retrospective analysis of the results from 1999 to 2005. Rofo 2008; 180: 325–331. doi: 10.1055/s-2008-1027144.