Catheter-directed thrombolysis for lower limb ischaemia: A retrospective study of treatment outcomes.

INTRODUCTION

Lower limb ischaemia secondary to occlusion of a lower limb artery is a limb-threatening condition that can be effectively treated by catheter-directed thrombolysis (CDT). The purpose of this study was to examine treatment outcomes of CDT both at the time of treatment and ongoing patency up to 12 months following treatment. The secondary aim of the study was to investigate the influence of age of occlusion and treatment duration on success and complication rates.

METHOD: A retrospective observational study was performed at a single institution over a 10-year period from 2010 to 2019. Data for patient demographics, vessel occlusion factors and treatment information were obtained and analysed. Patency data were investigated using Kaplan-Meier analyses.

RESULTS

A total of 218 limbs in 159 patients were treated during the study period. The aetiology of vessel occlusion was in situ thrombosis or occluded bypass graft in 74.5%. Technical success was achieved in 55.5% with CDT alone and 84.4% by using CDT in combination with adjunctive endovascular procedures (angioplasty or stenting). The overall probability of patency was 0.65 at 3 months and 0.44 at 12 months. The overall rate of major amputation within 30 days of thrombolysis was 8.2%. Thirty-day mortality was 6.3% and was secondary to intracranial haemorrhage in three patients.

CONCLUSION

Technical success of CDT was found to be significantly higher when combined with adjunctive endovascular procedures at the time of CDT. Despite an initial moderate technical success, the probability of patency at 12 months was only 44%. The likelihood of bleeding complications and technical and long-term success remain key considerations when selecting patients for CDT.