Outcome after thrombolysis for occluded endoprosthesis, bypasses and native arteries in patients with lower limb ischemia

Introduction: To report contemporary outcomes, and evaluate differences after thrombolysis for occluded endoprosthesis, bypasses and native artery occlusion in patients with lower limb ischemia.

Methods: Patients undergoing local intra-arterial thrombolysis for lower limb ischemia between 2001 and 2010 were identified in the prospective database for endovascular intervention, and analysis was performed retrospectively.

Results: There was an increase in thrombolysis for occluded endoprosthesis and a decrease in thrombolysis for occluded bypasses during the study period (p=0.001). The technical success rate for thrombolysis in occluded endoprosthesis, bypasses and native artery occlusion was 91%, 89% and 73%, respectively. The overall major amputation rate, mortality rate and amputation-free survival rate at 1 year was 19%, 14% and 73%, respectively, without differences between groups. The major amputation rate at long-term was highest, 45%, for patients with occluded synthetic bypass grafts. Female gender (HR 1.7; 95% CI 1.1-2.7), ischemic heart disease (HR 1.8; 95% CI 1.1-2.8), anemia at admission (HR 1.9; 95% CI 1.2-3.0), foot ulcer (HR 4.4; 95% CI 2.4-8.0), motor deficit at admission (HR 2.5; 95% CI 1.4-4.3), occluded synthetic bypass graft (HR 3.3; 95% CI 1.9-5.7) and failure of thrombolysis (HR 4.8; 95% CI 2.9-7.7) were independently associated with an increased long-term risk of major amputation.

Conclusions: Thrombolysis for occluded endoprosthesis, bypasses and native artery occlusion was effective. Female gender, ischemic heart disease, anemia, foot ulcer, motor deficit, occluded synthetic bypass graft and failure of thrombolysis were independently associated with an increased risk of major amputation.