Background: Thrombolysis is a common treatment for acute leg ischaemia. The purpose of this study was to evaluate different thrombolytic treatment strategies, and risk factors for complications. Methods: This was a retrospective analysis of prospective databases from two vascular centres. One centre used a higher dose of heparin and recombinant tissue plasminogen activator (rtPA). Results: Some 749 procedures in 644 patients of median age 73 years were studied; 353 (47.1 per cent) of the procedures were done in women. The aetiology of ischaemia was graft occlusion in 38.8 per cent, acute arterial thrombosis in 32.2 per cent, embolus in 22.3 per cent and popliteal aneurysm in 6.7 per cent. Concomitant heparin infusion was used in 63.2 per cent. The mean dose of rtPA administered was 21.0mg, with a mean duration of 25.2 h. Technical success was achieved in 80.2 per cent. Major amputation and death within 30 days occurred in 13.1 and 4.4 per cent respectively. Bleeding complications occurred in 227 treatments (30.3 per cent). Blood transfusion was needed in 104 (13.9 per cent). Three patients (0.4 per cent of procedures) had intracranial bleeding; all were fatal. Amputation-free survival was 83.6 per cent at 30 days at both centres. In multivariable analysis, preoperative severe ischaemia with motor deficit was the only independent risk factor for major bleeding (odds ratio (OR) 2.98; P < 0 001). Independent risk factors for fasciotomy were severe ischaemia (OR 2.94) and centre (OR 6 50). Embolic occlusion was protective for major amputation at less than 30 days (OR 0.30; P = 0.003). Independent risk factors for death within 30 days were cerebrovascular disease (OR 3.82) and renal insufficiency (OR 3.86). Conclusion: Both treatment strategies were successful in achieving revascularization with acceptable complication rates. Continuous heparin infusion during intra-arterial thrombolysis appeared to offer no advantage.
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机译：背景：溶栓是急性腿部缺血的常见治疗方法。这项研究的目的是评估不同的溶栓治疗策略和并发症的危险因素。方法：这是对来自两个血管中心的前瞻性数据库的回顾性分析。一个中心使用了更高剂量的肝素和重组组织纤溶酶原激活剂（rtPA）。结果：对644名中位年龄73岁的患者进行了749次手术；其中有353例手术（占47.1％）是在女性中完成的。缺血的病因是：移植物闭塞占38.8％，急性动脉血栓形成占32.2％，栓子占22.3％，pop动脉瘤占6.7％。伴随肝素输注的比例为63.2％。 rtPA的平均给药剂量为21.0mg，平均持续时间为25.2h。技术成功率达到80.2％。 30天之内的大截肢和死亡分别占13.1％和4.4％。 227例治疗发生了出血并发症（30.3％）。 104人（13.9％）需要输血。 3例（占手术的0.4％）颅内出血；都是致命的。两个中心的30天无截肢生存率均为83.6％。在多变量分析中，术前严重缺血并伴有运动缺陷是大出血的唯一独立危险因素（几率（OR）为2.98； P <0 001）。筋膜切开术的独立危险因素是严重缺血（OR 2.94）和中枢（OR 6 50）。栓塞闭塞可在不到30天的时间内对大面积截肢起到保护作用（OR 0.30； P = 0.003）。 30天内死亡的独立危险因素是脑血管疾病（OR 3.82）和肾功能不全（OR 3.86）。结论：两种治疗策略均能以可接受的并发症发生率成功实现血运重建。动脉内溶栓期间持续输注肝素似乎没有任何好处。
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