Successful outcomes with thrombolysis for limb ischemia with suprainguinal interventions, but high limb loss and mortality for infrainguinal disease

摘要

In this issue of Thrombosis Research, Kuoppala et al. [1] report a series of patients with acute lower extremity ischemia (ALI) treated with thrombolysis for occluded stents, bypass grafts and native arteries.The benefits of thrombolysis as an initial treatment of ALI were reported in a number of trials comparing surgical versus endovascular revascularization of acutely ischemic limbs. The use of catheter directed thrombolysis to treat acute limb ischemia has become part of routine clinical care in the past two decades, following the publication of two large randomized controlled trials which demonstrated at least equal efficacy compared to open surgical thrombectomy [2,3]. However, since the publication of these trials, thrombolysis has evolved such that current thrombolytic therapy and techniques differ significantly from those studied in the early trials. In light of the evolution of endovascular therapy for the treatment of ALI, with different devices and pharmacologic agents currently in use, recent papers have reported on the contemporary outcomes of thrombolysis for acute limb ischemia to determine if favorable outcomes continue to be achieved [4,5].