Ultrasound-accelerated thrombolysis for lower extremity ischemia: Multicenter experience and literature review
The Journal of Cardiovascular Surgery: a journal on cardiac, vascular and thoracic surgery , Volume 52 - Issue 4 p. 467- 476
Aim. This study evaluates the short-term outcome of ultrasound-accelerated thrombolysis in patients with lower extremity ischemia caused by thromboembolic occlusions. Methods. A retrospective cohort study was conducted from December 2008 to May 2011 of 57 patients (42 men; median age, 66±11 years) undergoing 62 episodes of ultrasound-accelerated thrombolysis for thromboembolic arterial occlusions of the lower extremities. The EKOS EndoWave System (EKOS Corporation, Bothell, WA, USA) was combined with urokinase (100000 IU/hour). Thirty-day and 6-month follow-up consisted of clinical evaluation, and Duplex scan or magnetic resonance angiography of the treated extremity. Results. Initial technical success was 97%, radiologic success was 82%, and overall clinical success was 77%. Median thrombolysis time was 21 hours (IQR, 15-24). In 38 of 51 procedures with successful lysis (75%) complete lysis was achieved within 24 hours. Major hemorrhage occurred in 2 procedures (3%), and distal embolization in 2 procedures (3%). During the initial hospitalization, the major amputation rate was 8% (N.=5) and the mortality rate was 2% (N.=1). The 30-day patency rate was 81%, without additional mortality. During a median 6-month (range, 2-14) followup, 9 reinterventions were performed. Two patients underwent major amputation and 3 patients died; because of malignancy (N.=2) and stroke (N.=1). Conclusion. Initial success rates of ultrasound-accelerated thrombolysis are high and complication rate is low. However, reintervention rate during short-term follow-up for recurrent ischemia is substantial. Results from a randomized controlled trial comparing ultrasound-accelerated thrombolysis with standard thrombolysis for lower extremity ischemia (DUET, Current Controlled Trials, ISRCTN72676102) are eagerly awaited.
|Ischemia, Lower extremity, Peripheral arterial disease, Thrombolytic therapy|
|The Journal of Cardiovascular Surgery: a journal on cardiac, vascular and thoracic surgery|
Schrijver, A.M, Vos, J.A, Hoksbergen, A.W.J, Fioole, B, Fritschy, W.M, Hulsebos, R.G, … de Vries, J.-P.P.M. (2011). Ultrasound-accelerated thrombolysis for lower extremity ischemia: Multicenter experience and literature review. The Journal of Cardiovascular Surgery: a journal on cardiac, vascular and thoracic surgery, 52(4), 467–476. Retrieved from http://hdl.handle.net/1765/85099