Feasibility and intermediate-term outcome of catheter-directed thrombolysis in management of acute nontraumatic viable and/or marginally threatened lower limb arterial thrombosis

Introduction
Although catheter-directed thrombolysis (CDT) has been shown to be an effective method to salvage the ischemic limb resulting from acute thrombotic occlusion and bypass graft thrombosis, bleeding complications remain a major problem of this treatment.
Aims
To evaluate the success rate, the patency rate, the limb salvage rate, and possible complications of CDT therapy in patients presented with acute nontraumatic unilateral lower limb ischemia.
Patients and methods
CDT was offered to patients with acute lower limb ischemia (ALI) who presented to Vascular Surgery Emergency Department at Cairo University hospitals in the period between May 2018 and December 2018. We only included patients with unilateral ALI with viable or marginally threatened limbs (Rutherford class I and class IIa).
Results
During the period from May 2018 till December 2018, we received 20 patients (12 males and eight females) who were admitted with acute unilateral lower limb ischemia, in whom CDT was done. The mean age of patients was 54.25±9.2 years (range, 36–73 years). Complete thrombolysis had been achieved in 14 (70%) cases, whereas in six cases, it was unsuccessful (30%), of which three (15%) cases had incomplete thrombolysis and in the other three (15%) cases thrombolysis failed. Above-knee amputation had been carried out to one of the failed thrombolysis cases, representing 5% of the total number of patients. All cases with successful thrombolysis have achieved 6-month follow-up with patent treated arteries (patency rate, 100%). Two (10%) patients died during the period of follow-up, both of them had successful thrombolysis and died within the first 4 weeks owing to medical problems unrelated to thrombolysis procedure (cardiac problems).
Conclusion
Thrombolysis remains a safe and effective alternative to surgery for treating ALI.