Management of complications during volume reduction therapy for peripheral arterial disease of lower extremities / 中国介入影像与治疗学

ABSTRACT

Objective To investigate the management of complications during volume reduction therapy for peripheral arterial disease of lower extremities. Methods: Data of 167 patients (188 limbs) with lower extremity peripheral arterial disease who underwent volume reduction therapy were retrospectively analyzed. According to methods of volume reduction treatment, the patients were divided into thrombolysis (43 cases, 46 limbs), thrombectomy (42 cases, 49 limbs) and directional atherectomy (82 cases, 93 limbs) groups. The kinds, incidence and symptomatic treatment of complications in each group, and the efficacy of the treatments were analyzed. Results: A total of 46 limbs were treated with catheter direct thrombolysis in thrombolysis group. In thrombectomy group, 16 limbs underwent thrombectomy with Angiojet catheter and 33 limbs underwent thrombectomy with Rotarex catheter. In directional atherectomy group, 21 limbs underwent atherectomy with Silverhawk system and 72 limbs underwent atherectomy with Turbohawk system. The total technical success rate of volume reduction therapy was 98.93% (186/188). The incidence of operative complications was 28.26%(13/46), 6.12%(3/49) and 6.45%(6/93) in group of thrombolysis, thrombectomy and directional atherectomy, respectively. Surgical complications included 14 cases (14 limbs) of vascular rupture and bleeding, 5 cases (5 limbs) of embolism caused by embolus, 2 cases (2 limbs) of acute thrombosis and 1 case (1 limb) of guide wire rupture, all were resolved after symptomatic treatments including compression, balloon attachment, covered stent implantation or thrombolysis. There was no operative related death. Statistical difference only existed in the incidences of bleeding among three groups (P=0.002). After the volume reduction treatments, Rutherford classification of the patients were significantly improved (Z=2.730, P=0.002). Conclusion: The effectiveness of volume reduction treatments are definite. Bleeding is the commonest complication, which is highest in patients underwent catheter direct thrombolysis. Timely treatments are helpful to avoid adverse events caused by operation-related complications of volume reduction therapy.