Regional thrombolysis in case of acute lower limb ischemia
A.V. MAKSIMOV1,2, E.A. GAYSINA1 , R.M. NURETDINOV1
¹Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan, 138 Orenburgskiy trakt, Kazan, Russian Federation, 420064
²KSMA — Branch Campus of the FSBEI FPE RMACPE MOH Russia, 36 Butlerov Str., Kazan, Russian Federation, 420012
Maksimov A.V. — D. Sc. (medicine), Head of the Vascular Surgery Division No.1, Associate Professor of the Department of Cardiology, X-ray Endovascular and Cardiovascular Surgery, e-mail: maks.av@mail.ru
Gaysina E.A. — PhD (medicine), Vascular Surgeon of the Vascular Surgery Division No.1, e-mail: kalbas77@yandex.ru, ORCID ID: 0000-0002-3035-4411
Nuretdinov R.M. — Vascular Surgeon of the Vascular Surgery Division No.1, e-mail: rifkat21@mail.ru, ORCID ID: 0000-0002-0954-0164
The results of thrombolytic therapy in 27 patients with acute limb ischemia are presented. According to I.I. Zatevahin the patients had: the 1st degree of ischemia — 13 people (48.1 %), the 2a degree of ischemia — 12 patients (44.4 %), the 2b degree of ischemia — 2 patients (7.4 %).
In 62.9 % of cases the clinical success of the procedure was achieved (17 patients), in 18.5 % of cases it was possible to achieve technical success in manipulating with full restoration of the angiographic and clinical picture. 48.1 % of patients (13 people) were required to undergo surgical or X-ray endovascular correction of the cause of thrombosis. Four patients (15.0 %) were amputated limbs due to failure of manipulation. Lethality was 3.7 % (1 patient).
Taking into account the active substance for thrombolytic therapy, all patients were divided into 2 groups. The 1st group (11 patients) received urokinase, the 2nd group (16 people) — recombinant tissue plasminogen activator. Clinical success was achieved in 36.4 % in the 1st group and in 81.3 % in the 2nd group. In the 1st group technical success was achieved in 9.1 % of cases, in the 2nd group — in 68.8 %. The frequency of amputations in the 1st group was 27.3 %, in the 2nd group — 6.3 %. Mortality in the 1st group reached 9.1 % (1 patient), in the 2nd group there were no lethal outcomes.
Key words: acute limb ischemia, regional thrombolysis.
(For citation: Maksimov A.V., Gaysina E.A., Nuretdinov R.M. Regional thrombolysis in case of acute lower limb ischemia. Practical Medicine. 2018)
REFERENCES
- Haimovici H., Ascer E., Hollier L.H., Strandness D.E. Jr and J.B. Towne (eds). Haimovici’s vascular surgery. Principles and Techniques. Pp. 1387. Illustrated. 1995. Oxford: Blackwell Science.
- Natsionalʹnye rekomendatsii po vedeniyu patsientov s sosudistoy arterialʹnoy patologiey (Rossiyskiy soglasitelʹnyy dokument). Chastʹ 1. Perifericheskie arterii [National guidelines for the management of patients with vascular arterial pathology (Russian agreement document). Part 1. Peripheral arteries]. Moscow: Izd-vo NTSSSKH im. A.N. Bakuleva, 2013. 78 p.
- Savelʹev B.C., Zatevakhin I.I., Stepanov N.V. Ostraya neprokhodimostʹ bifurkatsii aorty i magistralʹnykh arteriy konechnostey [Acute obstruction of aortic bifurcation and main arteries of the extremities]. Moscow: Meditsina, 1987. P. 307.
- Falkowski A. et al. Safety and efficacy of ultra-high-dose, short-term thrombolysis with rt-PA for acute lower limb ischemia. Eur J Vasc Endovasc Surg., 2013; 46 (1):118-123.