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Thorac Cardiovasc Surg 2015; 63(02): 164-167
DOI: 10.1055/s-0034-1378189
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Outcome after Preoperative or Intraoperative Use of Intra-arterial Urokinase Thrombolysis for Acute Popliteal Artery Thrombosis and Leg Ischemia

Roberto Gabrielli
1   Department of Vascular Surgery, Policlinico Casilino, Rome, Italy
2   Department of Vascular Surgery, Sapienza University, Anguillara Sabazia, Rome, Italy
,
Maria Sofia Rosati
1   Department of Vascular Surgery, Policlinico Casilino, Rome, Italy
,
Alessandro Carra
1   Department of Vascular Surgery, Policlinico Casilino, Rome, Italy
,
Silvio Vitale
1   Department of Vascular Surgery, Policlinico Casilino, Rome, Italy
,
Andrea Siani
1   Department of Vascular Surgery, Policlinico Casilino, Rome, Italy
› Author Affiliations
Further Information

Publication History

15 November 2013

16 April 2014

Publication Date:
09 June 2014 (online)

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Abstract

Objectives To evaluate the outcome of acute popliteal artery aneurysm (PAA) thrombosis and leg ischemia after preoperative or intraoperative use of intra-arterial urokinase thrombolysis.

Materials and Methods From 2000 to 2009, 86 patients with acute leg ischemia (Rutherford grade IB to IIA) from PAA thrombosis were treated by immediate surgery including intraoperative thrombolysis (group A: 47 cases) or preoperative thrombolysis (group B: 39 cases) followed by acute (<24 hours) or elective surgery. Chi-square tests for categorical data and time to event provided two-sided p values with a level of significance at 0.05 and all confidence intervals (CIs) at the 95% level.

Results The mean follow-up was 45 months. The 2-year primary patency was 61.7% (29/47) for group A and 43.6% (17/39) for group B (hazard ratio [HR] 1.85; 95% CI: 0.96 to 3.54; p = 0.06). The 2-year secondary patency was 70.2% (33/47) for group A and 53% (21/39) for group B (HR 1.86; 95% CI: 0.91 to 3.81; p = 0.08). One-month amputation rate was 18% in group A and 29% in group B (p < 0.001), and 12-month amputation rate was 19% (9/47) in group A and 44% (17/39) in B (p = 0.05). In group A, 28% of patients required fasciotomy and in group B, 59% (p < 0.05). Effective thrombolysis allowed 82% limb salvage patency in group B. No systemic or locoregional complications during thrombolysis were recorded, but four cases of worsening ischemia were recorded.

Conclusion Our results suggest that the immediate surgery with intraoperative thrombolysis improved the outcome of patients with acute leg ischemia due to PAA thrombosis in terms of limb salvage.

Keywords

popliteal artery aneurysm - acute leg ischemia - thrombolytic therapy - intraoperative thrombolysis
 

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