Catheter-Directed Thrombolysis for Acute Limb Ischemia in an Asian Population.

BACKGROUND: The incidence of peripheral arterial occlusions in Asian populations is likely to increase exponentially in the present and future decades due to the adapted Western lifestyle in metropolitan Asian life, extended life expectancies, and high rates of smoking. The literature on thrombolytic treatment of peripheral arterial occlusions in Asian populations is limited. Therefore, we evaluated the thrombolysis results in a real-world contemporary Asian cohort of patients with peripheral arterial occlusions. METHODS: Retrospective review of all electronic patient records of patients who underwent thrombolytic therapy for peripheral arterial occlusions between July 2011 and July 2016 was conducted. Outcomes were angiographic patency, clinical success, bleeding complications, amputation rates, and mortality rates. RESULTS: In total, 82 patients (median age 66 years, range 34-95) underwent catheter-directed thrombolysis. Median treatment duration was 26 hr (3-209). Angiographic patency and clinical success rates were 64% and 66%, respectively. Bleeding complications occurred in 12% of patients of which 6% were major. Amputation-free rates were 81%, 67%, and 63% for 30 days, 6 months, and 1 year, respectively. In-hospital mortality was 6%. CONCLUSIONS: This study demonstrates that thrombolytic treatment of peripheral arterial occlusions in an Asian patient cohort yields comparable treatment success rates to Western cohorts; however, higher rates of bleeding complications are hazardous and remain a detrimental drawback of this treatment.

Low-dose thrombolysis for thromboembolic lower extremity arterial occlusions is effective without major hemorrhagic complications.

OBJECTIVE: To evaluate the efficacy and bleeding complications associated with a low-dose thrombolysis protocol for thromboembolic lower extremity arterial occlusions. DESIGN: A retrospective cohort study. MATERIALS AND METHODS: A retrospective analysis was performed using data from all consecutive patients who underwent catheter-directed, intra-arterial thrombolysis for thromboembolic lower extremity arterial occlusions between January 2004 and May 2013. All patients were treated on a standard surgical ward. Endpoints were incidence of bleeding complications, duration of thrombolysis, angiographic patency rate, 30-day mortality rate, and amputation-free rate at 6 months. RESULTS: Of the 171 cases analyzed, 129 cases underwent low-dose thrombolysis and 42 underwent high-dose thrombolysis. No major bleeding complications occurred in the low-dose group versus 5% in the high-dose group (p = .01). The median duration of thrombolysis was 67 hours (4-304 hours) in the low-dose and 49 hours (2-171 hours) in the high-dose group (p = .027). Angiographic patency was restored in 67% of the cases in the low-dose group versus 79% of the high-dose group (p = .17). The 30-day mortality rates were 1% in the low-dose versus 5% in the high-dose group (p = .09). However, this higher mortality rate was not related to bleeding complications. Major amputation-free rates at 6 months were 81% in the low-dose group and 88% in the high-dose group (p = .22). CONCLUSIONS: Based on this data series, low-dose thrombolysis for thromboembolic lower extremity arterial occlusions is as effective as high-dose thrombolysis; however, the risk of major bleeding complications is substantially lower when using low-dose thrombolysis.