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Angiojet System Used in the Treatment of Submassive Pulmonary Embolism: A Case Report of Two Patients. Case Rep Vasc Med 2022; 2022:6867338. [PMID: 36051456 PMCID: PMC9427312 DOI: 10.1155/2022/6867338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Massive or submassive pulmonary embolism (PE) carries a high mortality. Percutaneous mechanical thrombectomy using the Angiojet system is accepted for the treatment of PE. Here, we reported two submassive PE cases who were treated with the Angiojet system successfully, to provide some advice for the therapy of submassive PE. Method Two patients with suffocation were admitted to our hospital. One patient was accompanied by lower blood pressure (20% lower than basal blood pressure) and higher pulmonary artery pressure (89 mmHg); the other patient had larger right ventricular transverse diameter (46 mm), decreased left ventricular end diastolic anteroposterior diameter (34 mm), and higher heartbeats (107 heartbeats per minute). Pulmonary artery computed tomography angiography showed bilateral pulmonary embolism. Result The Angiojet system with a high-pressure jet spray pattern (urokinase 25 wiu + sodium chloride injection 50 ml) was used. Intravascular thrombolysis by urokinase (100 wiu/day for 1 day) was done after being back in the ward. And low molecular weight heparin was used in hospitalization, and rivaroxaban was used after discharge. Both patients were treated successfully. However, the level of platelet was significantly lower in one patient after Angiojet system usage and recovered to the preoperative level the next day. Another patient suffered from bradyarrhythmias during the usage of Angiojet, and bradyarrhythmias disappeared when the Angiojet system stopped. Pulmonary embolism was cured after 3 months in both patients. Conclusion Angiojet could be a simple, safe, and well-tolerated treatment for massive or submassive PE. And hematocrit, platelet, kidney function, and heart rhythm should be monitored during perioperation.
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Kuznetsov MR, Iasnopol'skaia NV, Vinokurov IA, Fedorov EE, Shvedov PN. [Hybrid interventions for acute thrombosis after reconstructive operations on lower-limb arteries]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:71-78. [PMID: 35050251 DOI: 10.33529/angio2021423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND A steadily growing number of primary lower extremity arterial reconstructions is inevitably followed by the need to perform repeat interventions. Shunt reocclusion may become a cause of return of ischaemia to the initial level, may significantly increase the degree of limb-threatening chronic ischaemia, as well as lead to the development of an acute condition requiring urgent corrective measures to be taken. A reoperation currently continues to remain the standard of treatment. Despite advances in modern resuscitation, the postoperative mortality rate in such patients reaches 20%. AIM This study was aimed at assessing feasibility of hybrid technologies in acute thrombosis after reconstructive operations on lower-limb arteries. PATIENTS AND METHODS We retrospectively analysed the results of treatment of 66 consecutive patients urgently admitted to the City Clinical Hospital named after S.S. Yudin from 2015 to 2020 with acute lower limb ischaemia caused by acute occlusion of the zone of primary vascular reconstructions previously performed at other medical facilities. Depending on the method of surgical treatment, the patients were divided into two groups. The Study group included 20 patients subjected to open surgical interventions followed by angiographic control and using one or other type of X-ray-endovascular treatment. Endovascular interventions were performed for more than 70% stenoses in the major arteries and zone of the previously performed operation. The Comparison group comprised 46 patients treated without endovascular technologies. They were subjected to thrombectomy from the vascular construction with/without reconstructive-restorative operations. RESULTS Seventeen (85%) of the 20 Study group patients were operated on in a stagewise manner, with the first stage consisting of an open intervention - thrombectomy and reconstruction followed by angiographic control and roentgenendovascular treatment. The remaining three (15%) patients underwent simultaneous interventions. In the postoperative period, limb amputations were performed in ten (22%) Comparison group patients and in one (5%) Study group patient (p=0.049). There were three (7%) lethal outcomes in the Comparison group, with none in the Study group. CONCLUSION A combination of open and endovascular interventions in patients with shunt occlusion after vascular reconstructions makes it possible to reveal the cause of shunt occlusion, as well as to remove multilevel lesions, minimizing surgical wound and contributing to reducing the amputation rate.
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Affiliation(s)
- M R Kuznetsov
- Institute of Cluster Oncology named after L.L. Levshin, I.M. Sechenov First Moscow State Medical University of the RF Ministry of Public Health, Moscow, Russia; Department of Cardiovascular Surgery #1, City Clinical Hospital named after S.S. Yudin under the Moscow Healthcare Department, Moscow, Russia
| | - N V Iasnopol'skaia
- Department of Cardiovascular Surgery #1, City Clinical Hospital named after S.S. Yudin under the Moscow Healthcare Department, Moscow, Russia
| | - I A Vinokurov
- Department of Cardiovascular Surgery #1, City Clinical Hospital named after S.S. Yudin under the Moscow Healthcare Department, Moscow, Russia; Chair of Hospital Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky, I.M. Sechenov First Moscow State Medical University of the RF Ministry of Public Health, Moscow, Russia
| | - E E Fedorov
- Department of Cardiovascular Surgery #1, City Clinical Hospital named after S.S. Yudin under the Moscow Healthcare Department, Moscow, Russia
| | - P N Shvedov
- Department of Cardiovascular Surgery #1, City Clinical Hospital named after S.S. Yudin under the Moscow Healthcare Department, Moscow, Russia
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Abstract
Background: Endovascular therapy for acute lower limb ischemia (ALLI) has developed and
demonstrated safety and efficacy. The purpose of this study was to assess
clinical outcomes in patients treated for ALLI with conventional
endovascular or surgical revascularization. Method: This study was a retrospective single-center review. Consecutive patients
with ALLI treated with conventional endovascular revascularization (ER)
without thrombolytic agent or surgical revascularization (SR) between 2008
and 2014 were investigated. The 1 year and 3 year amputation rate and
mortality rate were assessed by time-to-event methods, including
Kaplan–Meier estimation. Result: A total of 64 limbs in 62 patients with ALLI due to thromboembolism or
thrombosis of a native artery, bypass graft, or previous stented vessel were
included. The majority of limbs (90.9%) presented with Rutherford clinical
categories 1 to 2 ischemia. Technical success rate was 95.5% in ER and 92.9%
in SR group (p = 0.547). Overall amputation rates were 9.1%
in ER versus 9.5% in SR after 1 year
(p = 0.971) and 9.1% in ER versus 11.9% in
SR after 3 year (p = 0.742). Overall mortality rates were
15% in ER versus 7.1% in SR after 1 year
(p = 0.491) and 15% in ER versus 11.2%
in SR after 3 year (p = 0.878). Conclusion: Endovascular or surgical revascularization of ALLI resulted in comparable
outcomes in limb salvage and mortality rate at 1 year and 3 year.
Conventional endovascular therapy without thrombolytic agent such as
stenting, balloon angioplasty, or catheter-directed thrombosuction may be
considered as a treatment option for ALLI.
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Affiliation(s)
- Keisuke Fukuda
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada City, Osaka, Japan 596-8522
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan
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Lind B, Morcos O, Ferral H, Chen A, Aquisto T, Lee S, Lee CJ. Endovascular Strategies in the Management of Acute Limb Ischemia. Vasc Specialist Int 2019; 35:4-9. [PMID: 30993101 PMCID: PMC6453593 DOI: 10.5758/vsi.2019.35.1.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Acute limb ischemia (ALI) represents one of the most common emergent scenarios encountered by a vascular specialist. Despite expedient revascularization, high rates of limb loss are reported along with high mortality rates which are second only to ruptured abdominal aortic aneurysms. Surgical revascularization is standard of care. Endovascular techniques as an alternative have emerged to be appropriate first line therapy when addressing the threatened limb. We review the etiology and classification of ALI and current endovascular techniques and evidence to date in the management of patients acutely presenting with extremity ischemia.
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Affiliation(s)
- Benjamin Lind
- Department of Surgery, Division of Vascular Surgery, Northshore University Health Systems, A Teaching Affiliate of the University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Omar Morcos
- Department of Surgery, Division of Vascular Surgery, Northshore University Health Systems, A Teaching Affiliate of the University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Hector Ferral
- Department of Radiology, Division of Interventional Radiology, Northshore University Health Systems, A Teaching Affiliate of the University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Allen Chen
- Department of Radiology, Division of Interventional Radiology, Northshore University Health Systems, A Teaching Affiliate of the University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Thomas Aquisto
- Department of Radiology, Division of Interventional Radiology, Northshore University Health Systems, A Teaching Affiliate of the University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Stephen Lee
- Department of Surgery, Division of Vascular Surgery, Northshore University Health Systems, A Teaching Affiliate of the University of Chicago Pritzker School of Medicine, Evanston, USA
| | - Cheong Jun Lee
- Department of Surgery, Division of Vascular Surgery, Northshore University Health Systems, A Teaching Affiliate of the University of Chicago Pritzker School of Medicine, Evanston, USA
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Shen Y, Wang X, Jin SS, Zhang RL, Zhao WJ, Chen G. Increased risk of acute kidney injury with percutaneous mechanical thrombectomy using AngioJet compared with catheter-directed thrombolysis. J Vasc Surg Venous Lymphat Disord 2019; 7:29-37. [DOI: 10.1016/j.jvsv.2018.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/03/2018] [Indexed: 12/28/2022]
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Escobar GA, Burks D, Abate MR, Faramawi MF, Ali AT, Lyons LC, Moursi MM, Smeds MR. Risk of Acute Kidney Injury after Percutaneous Pharmacomechanical Thrombectomy Using AngioJet in Venous and Arterial Thrombosis. Ann Vasc Surg 2017; 42:238-245. [DOI: 10.1016/j.avsg.2016.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/08/2016] [Accepted: 12/05/2016] [Indexed: 10/19/2022]
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Endovascular Treatment Strategy Using Catheter-Directed Thrombolysis, Percutaneous Aspiration Thromboembolectomy, and Angioplasty for Acute Upper Limb Ischemia. Cardiovasc Intervent Radiol 2017; 40:978-986. [DOI: 10.1007/s00270-017-1599-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 02/02/2017] [Indexed: 02/02/2023]
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Direct Stenting in Patients with Acute Lower Limb Arterial Occlusions: Immediate and Long-Term Results. Cardiovasc Intervent Radiol 2016; 40:192-201. [PMID: 27826790 DOI: 10.1007/s00270-016-1500-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to accentuate the efficacy of direct stenting (stent placement without predilatation of the lesion) in patients with acute lower limb arterial ischemia (ALLI). MATERIALS AND METHODS Between January 2010 and September 2015, 16 patients (11 men and 5 women) underwent direct stenting of acute arterial occlusions. All patients had contraindication for surgical revascularization or catheter-directed thrombolysis. According to SVS/ISCVS Classification, six patients had IIa and ten patients IIb ALLI. The occlusions were located in CIA, EIA, SFA, or popliteal artery. Mean follow-up time with clinical examination and color Duplex ultrasonography was 37.6 months (range 1-72). We analyzed the technical and clinical outcomes of the procedures, as well the complications and patency rates. RESULTS Technical success was achieved in all patients (16/16) and there was significant clinical improvement in 15 patients. There was neither distal embolization nor procedure-related complications. During the 6 years of follow-up, four patients died due to non-procedure-related causes and there were two minor and one major amputations. The primary patency rates and the amputation-free survival rates were 93.7 and 87% at 1 year, 75.2 and 71.2% at 3 years, and 75.2 and 62.3%, respectively, at 6 years. CONCLUSIONS Direct stenting may be a valuable alternative procedure for acute arterial occlusions in selected cases with high technical success and significant clinical improvement. LEVEL OF EVIDENCE Level 4, Case Series.
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Karnabatidis D, Spiliopoulos S, Tsetis D, Siablis D. Quality improvement guidelines for percutaneous catheter-directed intra-arterial thrombolysis and mechanical thrombectomy for acute lower-limb ischemia. Cardiovasc Intervent Radiol 2011; 34:1123-36. [PMID: 21882081 DOI: 10.1007/s00270-011-0258-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 07/27/2011] [Indexed: 02/08/2023]
Abstract
Percutaneous catheter-directed intra-arterial thrombolysis is a safe and effective method of treating acute and subacute lower limb ischemia, as long as accurate patient selection and procedural monitoring are ensured. Although larger, controlled trials are needed to establish the role of PTDs in ALI, mechanical thrombectomy could currently be applied combined with lytic infusion in selected cases where rapid recanalization is required or as a stand-alone therapy when the administration of thrombolytic agents is contraindicated.
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Affiliation(s)
- Dimitris Karnabatidis
- Department of Radiology, Patras University Hospital, School of Medicine, Rion, Greece.
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Kim SK, Kwak HS, Chung GH, Han YM. Acute upper limb ischemia due to cardiac origin thromboembolism: the usefulness of percutaneous aspiration thromboembolectomy via a transbrachial approach. Korean J Radiol 2011; 12:595-601. [PMID: 21927561 PMCID: PMC3168801 DOI: 10.3348/kjr.2011.12.5.595] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 04/15/2011] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the usefulness of percutaneous aspiration thromboembolectomy (PAT) via a transbrachial approach in patients with acute upper limb ischemia. Materials and Methods From July 2004 to March 2008, eleven patients with acute upper limb ischemia were enrolled in this study. They were initially treated with thrombolysis (n = 1), PAT (n = 6), or both (n = 4) via a femoral artery approach. However, all of the patients had residual thrombus in the brachial artery, which was subsequently managed by PAT via the transbrachial approach for removal of residual emboli. Results Successful re-canalization after PAT via a transbrachial approach was achieved in all patients. Two patients experienced early complications: one experienced a massive hematoma of the upper arm due to incomplete compression and was treated by stent deployment. The other patient experienced a re-occlusion of the brachial artery the day after the procedure due to excessive manual compression of the puncture site, but did not show recurrence of ischemic symptoms in the artery of the upper arm. Clinical success with complete resolution of ischemic symptoms was achieved in all patients. Conclusion PAT via a transbrachial approach is a safe and effective treatment for patients with acute upper limb ischemia.
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Affiliation(s)
- Sung-Kwan Kim
- Department of Radiology, Chonbuk National University Hospital & Medical School, Jeonbuk 561-712, Korea
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11
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Neurological symptoms in acute Leriche’s syndrome. Clin Res Cardiol 2010; 99:459-62. [DOI: 10.1007/s00392-010-0121-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 01/20/2010] [Indexed: 01/16/2023]
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12
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Allaqaband S, Kirvaitis R, Jan F, Bajwa T. Endovascular treatment of peripheral vascular disease. Curr Probl Cardiol 2009; 34:359-476. [PMID: 19664498 DOI: 10.1016/j.cpcardiol.2009.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Peripheral arterial disease (PAD) affects about 27 million people in North America and Europe, accounting for up to 413,000 hospitalizations per year with 88,000 hospitalizations involving the lower extremities and 28,000 involving embolectomy or thrombectomy of lower limb arteries. Many patients are asymptomatic and, among symptomatic patients, atypical symptoms are more common than classic claudication. Peripheral arterial disease also correlates strongly with risk of major cardiovascular events, and patients with PAD have a high prevalence of coexistent coronary and cerebrovascular disease. Because the prevalence of PAD increases progressively with age, PAD is a growing clinical problem due to the increasingly aged population in the United States and other developed countries. Until recently, vascular surgical procedures were the only alternative to medical therapy in such patients. Today, endovascular practice, percutaneous transluminal angioplasty with or without stenting, is used far more frequently for all types of lower extremity occlusive lesions, reflecting the continuing advances in imaging techniques, angioplasty equipment, and endovascular expertise. The role of endovascular intervention in the treatment of limb-threatening ischemia is also expanding, and its promise of limb salvage and symptom relief with reduced morbidity and mortality makes percutaneous transluminal angioplasty/stenting an attractive alternative to surgery and, as most endovascular interventions are performed on an outpatient basis, hospital costs are cut considerably. In this monograph we discuss current endovascular intervention for treatment of occlusive PAD, aneurysmal arterial disease, and venous occlusive disease.
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Plate G, Oredsson S, Lanke J. When is Thrombolysis for Acute Lower Limb Ischemia Worthwhile? Eur J Vasc Endovasc Surg 2009; 37:206-12. [DOI: 10.1016/j.ejvs.2008.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 11/07/2008] [Indexed: 11/25/2022]
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Ansel GM, Botti CF, Silver MJ. Treatment of acute limb ischemia with a percutaneous mechanical thrombectomy-based endovascular approach: 5-year limb salvage and survival results from a single center series. Catheter Cardiovasc Interv 2008; 72:325-330. [DOI: 10.1002/ccd.21641] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Namdari S, Park MJ, Weiss APC, Carney WI. Chronic hand ischemia treated with radial artery balloon angioplasty: case report. J Hand Surg Am 2008; 33:551-4. [PMID: 18406959 DOI: 10.1016/j.jhsa.2007.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 12/27/2007] [Accepted: 12/31/2007] [Indexed: 02/02/2023]
Abstract
Although balloon angioplasty in heart and lower extremity vessels has been extensively studied and reported, little information exists regarding its use for digital ischemia in the hand. We report a case of successful balloon angioplasty of the distal radial artery to reverse present and prevent further digital tip cyanosis and necrosis.
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Affiliation(s)
- Surena Namdari
- Division of Vascular Surgery and the Department of Orthopaedics, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
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16
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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; 31:651-60. [PMID: 16427339 DOI: 10.1016/j.ejvs.2005.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2005] [Accepted: 11/17/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To test if initial high-dose, pulse-spray thrombolysis improves the early and late outcome of lower limb ischaemia as compared with low-dose infusion alone. DESIGN Prospective randomised multicentre study. MATERIAL AND METHODS Patients with acute and sub-acute (<30 days) lower limb ischaemia were randomised following angiography. Group 1 (n=58) received pulse-spray infusion of recombinant plasminogen activator (rt-PA, 15 mg/h) for 2h followed by low-dose infusion if needed. Group 2 (n=63) were only treated with low-dose infusion (0.5mg/h) of rt-PA for 48 h. Underlying lesions were corrected if required. RESULTS The study was stopped prematurely. Complications were equally frequent in both groups. More than 75% lysis was accomplished in 78 versus 67% of the patients (p=0.21). Primary endpoints (re-occlusion, incomplete lysis, life-threatening complication, amputation, or death) were reached in 24 versus 32% of the patients (p=0.35). Neither vascular patency nor clinical parameters differed during the first year, but re-interventions tended to be more frequent (p=0.040 at 1 month; p=0.090 at 1 year) and of a greater magnitude (p=0.028) in group 2. CONCLUSIONS There was no obvious advantage with initial high-dose thrombolysis, which may be a type-2 error. A reduction of major re-interventions was recorded.
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Affiliation(s)
- G Plate
- Department of Surgery, Central Hospital, Helsingborg, Sweden.
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Semba CP, Weck S, Razavi MK, Setum CM, Patapoff T. Characterization of alteplase (tPA) following delivery through the AngioJet rheolytic catheter. J Endovasc Ther 2005; 12:123-8. [PMID: 15683263 DOI: 10.1583/04-1376.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To analyze alteplase solutions following delivery through the AngioJet Xpeedior rheolytic thrombectomy device to characterize the viability of proteins exposed to high shear stress. METHODS Alteplase solutions were prepared by reconstitution in sterile water to obtain a targeted concentration of 1.0 mg/mL. A baseline control sample was obtained. The AngioJet system was modified by occluding the return line to allow collection of the dispersed fluid volume. Alteplase solutions (n=5) were delivered through the 6-F, 120-cm Xpeedior catheter and collected. All samples were assayed and compared to baseline using qualitative visual inspection, ultraviolet spectrophotometry, size exclusion chromatography, and in vitro clot lysis assays. RESULTS Analysis of the test solutions demonstrated a mean protein recovery of 98.0%+/-3.5% of targeted concentration; the collected protein was fully active, as determined by clot lysis assays (specific activity > or =100%). All samples were clear and colorless. No significant fragmentation or aggregation of protein was observed. CONCLUSIONS Alteplase solutions, when delivered through the AngioJet Xpeedior rheolytic thrombectomy device, remain stable and biologically active in vitro. Further clinical investigation is warranted using this method as a novel approach for pharmacomechanical thrombolysis.
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Affiliation(s)
- Charles P Semba
- Division of Vascular Medicine and Neurology, Genentech, Inc., South San Francisco, CA 94080-4990, USA.
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Schmittling ZC, Hodgson KJ. Thrombolysis and mechanical thrombectomy for arterial disease. Surg Clin North Am 2004; 84:1237-66, v-vi. [PMID: 15364553 DOI: 10.1016/j.suc.2004.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Thrombolytic therapy has been around for close to 30 years now,but its exact role in the treatment of acute and chronic arterial occlusive disease continues to be debated. Studies have produced varying and contradictory results. We are still not sure if thrombolysis has any true advantages over surgical thromboembolectomy,or which lytic agent is the best. Nonetheless, the technique still plays an important role in the treatment of arterial occlusions.
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Affiliation(s)
- Zachary C Schmittling
- Division of Vascular Surgery, Department of Surgery, Southern Illinois University School of Medicine, 751 N. Rutledge, Room 1700, Box 19638, Springfield, IL 62794, USA
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