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[Intraarterial thrombolysis in acute limb ischaemia: alternative treatment and basic principles of further interventions].

Abstract：

INTRODUCTION:Intraarterial thrombolysis of acute arterial occlusions in the lower limbs is an established therapeutic procedure. However, its value as a primary treatment is discussed controversially and it is mostly seen as a competing procedure to primary vascular surgical interventions. METHODS:From January 2001 to December 2004, we performed a total of 132 intraarterial thrombolysis procedures in 112 patients with acute or subacute ischaemia of the lower limbs. In the majority of the cases, there was an ischaemia of stage I or II a according to Rutherford, a few further cases were in stage II b at the start of treatment. The patients' ages at the time of thrombolysis was 64.7+/-11.3 years (mean value+/-standard deviation, range: 27-91 years). There were 46 female and 86 male patients. RESULTS:The average duration of thrombolysis was 35.2+/-20.8 hours (mean+/-standard deviation, range: 6-142 hours). As median 2 (range: 0-8) angiographic controls were performed. In 100 cases (75.8%), an operation could be avoided by thrombolysis alone or in combination with an supplementary intervention. On the other hand, in 32 cases (24.2%) a subsequent operative therapy including 10 major amputations (7.6%) was necessary. Because of hemorrhagic complications, 15 thrombolysis procedures (11.4%) had to be terminated prematurely but only 2 patients required an inguinal revision. Therapy-related mortality was 0.8% (1 patient). CONCLUSION:In the majority of our patients, primary intraarterial thrombolysis was successful and often led to the discovery of the underlying vascular lesion. It can serve both as a therapeutic alternative to a primary vascular surgical intervention and as the foundation further interventional or vascular surgical therapies although this cannot always be predicted for individual cases.

journal_name

Zentralbl Chir

journal_title

Zentralblatt fur Chirurgie

authors

Weinrich M,Justinger C,Köhler M,Frech R,Schilling M,Kreissler-Haag D

doi

10.1055/s-2008-1076866

subject

Has Abstract

pub_date

2008-08-01 00:00:00

pages

355-8

issue

eissn

0044-409X

issn

1438-9592

journal_volume

133

pub_type

杂志文章

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[Intraarterial thrombolysis in acute limb ischaemia: alternative treatment and basic principles of further interventions].