Early Experience of Catheter Directed Thrombolysis for Acute Limb Ischemia of Native Vessels and Bypass Graft Thrombosis in Thai Patients
Sarawut Limtungturakul MD*, Nattawut Wongpraparut MD, FACP, FACC, FSCAI*, Suwatchai Pornratanarangsri MD*, Damras Tresukosol MD, FSCAI, FAPSIC*, Chaneon Ruansetakit MD**, Pramook Mutirangura MD**, Rungtiwa Pongakasira Bsc**
Affiliation : * Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand ** Division of Vascular surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
Objective : We assessed the efficacy and safety of catheter directed thrombolysis in the patients with acute limb ischemia who
have been treated with catheter directed thrombolysis.
Background : From the ACC/AHA 2005 Practice Guidelines for the Management of Patients with Peripheral Arterial
Disease, Catheter-based thrombolysis is an effective and beneficial therapy and is indicated for patients with acute limb
ischemia (Rutherford categories I and IIa) of less than 14 days’duration. To date, there is no data concerning such treatment
in Thai patients.
Material and Method: We retrospectively reviewed data of 66 patients with acute limb ischemia who underwent catheter
directed thrombolysis (CDT) at Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital
between January 2005 and January 2010.
Results : Sites of target vessel for CDT were at vascular bypass graft thrombosis (59%) followed by the native vessels artery
(41%). Overall technical success rate was 92%. Re-establisment of blood flow was successful from catheter only directed
thrombolysis in 41 patients (65%). The other 22 patients needed additional mechanical thrombectomy. Five patients (8%)
could not reestablish blood flow after catheter directed thrombolysis with mechanical thrombectomy and underwent bypass
surgery. After successful CDT, ulcer improvement occurred in 71.42%. ABI improved from 0.45 to 0.93. Major bleeding
complications occurred in 4 cases (6%), 1 case due to retroperitoneal bleeding and the other 3 cases due to hemorrhagic
stroke (4.5%). The predictor for hemorrhagic stroke was being in the higher age group (72 + 1.2 vs. 66.7 + 1.8, p = 0.02).
Conclusion : Catheter directed thrombolysis for treatment of acute limb ischemia in native artery occlusion or bypass graft
thrombosis in Thai population has a 92% success rate with an acceptable bleeding complication rate similar to prior
published studies. However, the incidence of hemorrhagic stroke is higher in patients older than 70 years.
Keywords : Catheter directed thrombolysis, Mechanical thrombectomy, Acute limb ischemia
