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Manual high-dose regional intraoperative thrombolysis of lower extremity emboli after open repair of a ruptured abdominal aortic aneurysm.

Abstract：

:We describe a case of high-dose regional intraoperative thrombolysis subsequent to mechanical thrombectomy for the treatment of postoperative distal extremity embolization of the right lower limb owing to open repair of a ruptured abdominal aortic aneurysm. Mechanical thrombectomy was performed from the popliteal artery but residual embolic occlusion of all three tibial arteries remained. The limb was elevated, exsanguinated, and a blood cuff was placed below the knee and inflated to suprasystolic pressure to isolate the limb from systemic circulation. An 18-gauge infusion catheter was introduced to the exposed dorsalis pedis artery. Subsequently, the exposed great saphenous vein was cannulated and drained. A total of 100 mg of recombinant tissue-type plasminogen activator diluted in 500 mL of saline was infused into the anterior tibial artery with a slow hand infusion for 30 minutes. The infusion was continuously collected through the great saphenous cannulation and a closed loop was confirmed by angiogram. The limb was flushed with heparin and saline solution. Infusion catheter was extracted and the great saphenous vein was ligated. Blood cuff was removed, arterial flow was re-established, and a postprocedural arteriogram confirmed successful revascularization. This method may be an alternative to microtibial embolectomy at the foot ankle level after severe lower limb embolization after acute open repair of a ruptured abdominal aortic aneurysm.

journal_name

Ann Vasc Surg

journal_title

Annals of vascular surgery

authors

Bakoyiannis CN,Kafeza M,Economopoulos KP,Tsekouras N,Georgopoulos S,Papalambros E

doi

10.1016/j.avsg.2011.03.010

subject

Has Abstract

pub_date

2011-10-01 00:00:00

pages

981.e13-6

issue

7

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(11)00220-2

journal_volume

25

pub_type

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