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

Abstract

Three randomized, multicentre trials were published comparing thrombolysis with surgery: the Rochester study [1], the Surgery versus Thrombolysis for Ischemic Lower Extremity (STILE) trial, [2] and the Thrombolysis Or Peripheral Arterial Surgery (TOPAS) trial [3]. The consensus that emerged from these studies and others was that CDT should be considered as irst-line treatment for acute limb ischemia under the following conditions: (1) symptoms of limb ischemia present for < 14 days, (2) no absolute contraindications to thrombolysis, and (3) the predicted time to re-establish antegrade low is short enough to preserve limb viability. Barring contraindications, CDT is indicated urgently for patients with marginal limb threat (category IIa according to the TASC criteria). Patients with immediate limb threat (category IIb) often require emergent operation as thrombolysis alone will not re-establish perfusion quickly enough to salvage the limb. Nonetheless, surgery incurs the risk of systemic effects of rapid reperfusion with compromise of cardiac, pulmonary, and renal functions that may result in prolonged hospitalization or even death [4,5]. If the cardiovascular risks of general anaesthesia due to comorbid disease and status of the affected limb outweigh the risk of a delay in reperfusion, then thrombolysis may be the best option. Last resort specialised interventional procedures and primary amputation is the only option permitting survival for patients with irreversible ischemia (category III). High perioperative mortality is associated with this degree of acute ischemia.