Intravascular fibrinolysis in treating the thromboembolic changes in lower limbs

Abstract

Introduction. One of the methods of treating the limbs ischaemia is local intravascular fibrinolysis. The aim of using this method is fast restoration of arteries patency what enables blood flow to the ischaemic limb and allows to diagnose the cause of the occlusion of arteries or a vascular bypass. Identification and determination of the changes type in the arterial wall allows to plan further treatment using surgical and endovascular methods.

Material and methods. During 2003–2014, 41 patients were treated using the method of local fibrinolysis. In all of the cases the occlusion occurred in the femoropopliteal section. All of the patients had the colour Doppler echocardiography carried out, and then angiography, to confirm the diagnosis. The catheter was inserted through a puncture in the common femoral artery. The catheter tip was placed above the arterial thrombus. In 2003–2005 streptokinase was used as the fibrinolytic drug. Then, in 2005–2014 the usage of rtPA (alteplase) had been started. The progress of thrombolysis was monitored by repeated angiography. The fibrinolytic treatment had been continued for 6 more hours from obtaining the vessel patency confirmed by radiology.

Results. In 15 patients (88%) in 2003–2005 (group in which streptokinase was used) and 21 patients (87.5%) in 2005–2014 (group in which alteplase was used) patency of the initially clotted artery and full remission of the ischaemic limb symptoms was obtained. In 4 cases the intravascular thrombolysis ended with failure. Simultaneously, embolectomy with Fogarty’s catheter was carried out. In the group treated with rtPA two deaths were noted: due to acute coronary syndrome and hypertensive crisis.

Conclusions. Local intravascular fibrinolysis is a good and effective method of treatment of the limbs ischaemia in certain patients. It allows to lower the dosages of the thrombolytic drugs and can be a good alternative for the surgical treatment.