Abstract

Mini Review

Bleeding complications at the access sites during catheter directed thrombolysis for acute limb ischaemia: Mini review

Elias Noory*, Tanja Böhme, Ulrich Beschorner and Thomas Zeller

Published: 03 March, 2021 | Volume 5 - Issue 1 | Pages: 001-003

Acute and subacute ischemia of the lower limbs represents a major emergency with a high in-hospital mortality, complication, and leg amputation rates.

Treatment options for acute limb ischemia include systemic anticoagulation, followed by various catheter based options including infusion of fibrinolytic agents (pharmacological thrombolysis), pharmacomechanical thrombolysis, catheter-mediated thrombus aspiration, mechanical thrombectomy, and any combination of the above or open surgical intervention (thromboembolectomy or surgical bypass).

Minor and major bleeding complication during catheter directed thrombolysis (CDT) especially at access site are frequent. Bleeding complications require often an interruption or termination of CDT affecting clinical outcome of the patients. Recently we examined a new access site bleeding protection device during CDT.

Read Full Article HTML DOI: 10.29328/journal.avm.1001014 Cite this Article Read Full Article PDF

Keywords:

Acute limb ischemia; Peripheral artery disease; Thrombectomy; Catheter directed thrombolysis; Protection device; Bleeding complications

References

  1. Ouriel K, Shortell CK, De Weese JA, Green RM, Francis CW, et al. A comparison of thrombolytic therapy with operative vascularization in the initial treatment of acute peripheral arterial ischemia. J Vasc Surg. 1994; 19: 1021–1030. PubMed: https://pubmed.ncbi.nlm.nih.gov/8201703/
  2. Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischaemia of the lower extremity. The STILE trial. Ann Surg. 1994; 220: 251–268. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234376
  3. Ouriel K, Veith FJ, Sasahara AA. Thrombolysis or peripheral arterial surgery: phase I results. TOPASInvestigators.J Vasc Surg. 1996; 23: 64-73. PubMed: https://pubmed.ncbi.nlm.nih.gov/8558744/
  4. Diffin DC, Kandarpa K. Assessment of peripheral intra-arterial thrombolysis versus surgical revascularization in acute lower-limb ischemia: a review of limb-salvage and mortality statistics. J Vasc Interv Radiol. 1994; 7: 57–63. PubMed: https://pubmed.ncbi.nlm.nih.gov/8773976/
  5. Beyersdorf F, Matheis G, Kruger S. Avoiding reperfusion injury after limb revascularization: experimental observations and recommendations for clinical application. J Vasc Surg. 1989; 9: 757–766.
  6. Robertson I, Kesse DO, Berridge DC. Fibrinolytic agents for peripheral arterial occlusion. Cochrane Database Syst Rev. 2013; 12: CD001099. PubMed: https://pubmed.ncbi.nlm.nih.gov/24357258/
  7. Ebben HP, Jongkind V, Wisselink W, Hoksbergen A, Yeung KK. Catheter Directed Thrombolysis Protocols for Peripheral Arterial Occlusions: a Systematic Review European Journal of Vascular & Endovascular Surgery, Eur. J.Vasc. Endovasc. Surg. 2019; 57: 667-675. PubMed: https://pubmed.ncbi.nlm.nih.gov/31005512/
  8. Verhamme P, Heye S, Peerlinck K, Cahillane G, Tangelder M, et al. Catheter-directed thrombolysis with microplasmin for acute peripheral arterial occlusion (PAO): an exploratory study. Int Angiol. 2012; 31: 289–296. PubMed: https://pubmed.ncbi.nlm.nih.gov/22634985/
  9. Kühn JP, Hoene A, Miertsch M, Traeger T, Langner S, et al. Intraarterial Recombinant Tissue Plasminogen Activator Thrombolysis of Acute and Semiacute Lower Limb Arterial Occlusion: Quality Assurance, Complication Management, and 12-Month Follow-Up Reinterventions. Am J Roentgenol. 2011; 196: 1189–1193. PubMed: https://pubmed.ncbi.nlm.nih.gov/21512091/
  10. Grip O, Kuoppala M, Acosta S, Wanhainen A, Åkeson J, et al. Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion. Br J Surg. 2014; 101: 1105–1112. PubMed: https://pubmed.ncbi.nlm.nih.gov/24965149/
  11. Plate G, Jansson I, Forssell C, Weber P, Oredsson S. Thrombolysis for Acute Lower Limb Ischaemia—A Prospective, Randomised, Multicentre Study Comparing Two Strategies. Eur J Vasc Endovasc Surg. 2006; 31: 651–660. PubMed: https://pubmed.ncbi.nlm.nih.gov/16427339/
  12. Ricco JB, Schneider F. Angio-Seal hopes for antegrade puncture require better evidence. Eur J Vasc Endovasc Surg. 2014; 48: 226–227. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24951375
  13. Noory E, Beschorner U, Zeller T, Böhme T. A new protection system to avoid major bleeding at puncture sites -results from the first in men study. Cardiol Cardiovasc Med. 2000; 4: 717-728.

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