RESUMO
OBJECTIVE: We assessed the efficacy and safety of catheter directed thrombolysis in the patients with acute limb ischemia who have been treated with catheter directed thrombolysis. BACKGROUND: From the ACC/AHA 2005 Practice Guidelines for the Management of Patients with Peripheral Arterial Disease, Catheter-based thrombolysis is an effective and beneficial therapy and is indicated for patients with acute limb ischemia (Rutherford categories I and IIa) of less than 14 days'duration. To date, there is no data concerning such treatment in Thai patients. MATERIAL AND METHOD: We retrospectively reviewed data of 66 patients with acute limb ischemia who underwent catheter directed thrombolysis (CDT) at Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital between January 2005 and January 2010. RESULTS: Sites of target vessel for CDT were at vascular bypass graft thrombosis (59%) followed by the native vessels artery (41%). Overall technical success rate was 92%. Re-establishment of blood flow was successful from catheter only directed thrombolysis in 41 patients (65%). The other 22 patients needed additional mechanical thrombectomy. Five patients (8%) could not reestablish blood flow after catheter directed thrombolysis with mechanical thrombectomy and underwent bypass surgery. After successful CDT ulcer improvement occurred in 71.42%. ABI improved from 0.45 to 0.93. Major bleeding complications occurred in 4 cases (6%), 1 case due to retroperitoneal bleeding and the other 3 cases due to hemorrhagic stroke (4.5%). The predictor for hemorrhagic stroke was being in the higher age group (72 +/- 1.2 vs. 66.7 +/- 1.8, p = 0.02). CONCLUSION: Catheter directed thrombolysis for treatment of acute limb ischemia in native artery occlusion or bypass graft thrombosis in Thai population has a 92% success rate with an acceptable bleeding complication rate similar to prior published studies. However, the incidence of hemorrhagic stroke is higher in patients older than 70 years.
