EFFICACY AND IMPACT OF CATHETER-DIRECTED THROMBOLYSIS THERAPY IN ACUTE LOWER LIMB ISCHEMIA BY USING ALTEPLASE

Background: Percutaneous catheter directed intra-arterial thrombolysis (CDT) is considered an important 
alternative in the treatment of patients with acute lower limb ischemia due to arterial or graft occlusion. 
Aim of Work: is to assess efficacy and impact of CDT in patients suffering from acute lower limb arterial 
occlusion using alteplase. 
Patients and Methods: 240 patients (138 males and 102 females) mean age 67.39±12 years (Range 15-91 years) 
with acute lower limb ischemia due to thromobembolic occlusion of the native vessel or bypass graft of the 
lower limb were included. They were admitted (September 2010- September 2012) in Vascular Surgery 
Department, St. Franziskus Hospital, Muenster, Germany. Patients were treated by CDT using alteplase 
(recombinant tissue plasminogen activator). Results of the procedure, the success rate and complications were 
recorded directly after the procedure and then one year after. 
Results: Patients were presented with claudication in 45.4%, rest pain in 43.8% and tissue loss in 10.8%. The 
ischemic interval ranged from 1 hour to 30 days (mean 8.53 ±1.3 days). There were 142 native arterial 
occlusion (59.2%) and 98 bypass grafts occlusion (40.8%). CDT showed immediate technical success rate of 
79.6%. The primary patency rate at 30 days and 12 months was 88.9% and 57.9% respectively. Amputation 
free survival at 30 days and 12 months was 99.5% and 95.9% respectively. There was a significantly better 
success results in patients presented with claudication or rest pain and patients with higher ABI than those 
with tissue loss or lower ABI (p=0.01 for each). Dacron graft is significantly liable to higher success rate p<0.05 
than other types of bypass grafts. There was no significant difference between groups of patients with 
different risk factors, gender or age, groups with native artery or bypass graft occlusion regarding the success 
results. There is no significant difference between types of occlusion, lengths of occlusion or number of distal 
run off vessels regarding the success results. Adjunctive therapy in the form of PTA, PTA with stenting, 
mechanical thrombectomy was used in 81% of patients. Secondary procedures as surgical, endovascular or 
conservative therapy was done in 47%. The morbidity rate was 30% and bleeding was the most common 
complication (11.3%). The mortality rate was 2% (five deaths from cerebral hemorrhage). 
Conclusion: CDT combined with adjunctive therapies, is effective and safe in the treatment of patients with 
acute lower limb ischemia with occluded native artery or bypass graft. Better prognosis is obtained in patients 
with non-severe ischemia and higher ABI. This could reduce the need for open surgical procedures and could 
be considered an excellent alternative for surgery when it is not the best choice for such cases.