Keywords
arterial hypertension
revascularization
limb survival
anticoagulant therapy
How to Cite
Abstract
Aim. To evaluate the effectiveness of catheter-directed thrombolysis (CDT) in patients with critical lower limb ischemia (CLI) due to thromboembolic arterial occlusions and to study the long-term outcomes of the treatment.
Materials and methods. Over 2020-2023, 35 patients (13 females, 22 males, aged 53-75) were studied. A total of 57% of patients had femoro-popliteal and below-the-knee (BTK) thromboclusion, 43% had BTK thrombotic occlusion. The study included 35 patients with acute limb ischemia (ALI) classified as Rutherford Category IIA-IIB: 17 patients (48.6%) in Category IIA and 18 patients (51.4%) in Category IIB. All patients underwent catheter-directed thrombolysis (CDT) after diagnostic arteriography and confirmation of acute lower limb arterial thrombosis (ALLAT) with involvement of the outflow arteries.
Results. In most patients, significant ischemia regression, pain relief, and absence of critical haemorrhagic complications were observed. In 93.3% of patients, limb preservation was achieved within 2 months after CDT. Limb preservation was achieved in all 11 (100%) patients. CDT combined with percutaneous transluminal angioplasty (PTA) does not affect the frequency of rethrombosis in the revascularized segment, with a p-value of 0.0185 (statistical significance determined by the one-sided Fisher's exact test). The use of CDT led to a high frequency of revascularization and a reduced risk of recurrent thrombosis. One (20%) of the 5 patients who underwent CDT (catheter-directed thrombolysis) developed lower limb arterial rethrombosis, leading to subsequent amputation.
Conclusions. CDT is an effective treatment method for patients with lower limb arterial thrombosis and arterial outflow lesions. It provides a high rate of revascularization, significant symptom relief, and a low risk of complications. Regular monitoring and anticoagulant therapy are essential to maintain treatment effectiveness and prevent recurrences. Optimising the CDT protocol in patients and ensuring close monitoring during treatment are critically important for identifying cases that may require alternative interventions. A key component in preventing rethrombosis is long-term angiographic follow-up after CDT to identify causative stenoses or subocclusions involved in ALLAT progression.
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