Transcatheter thrombolysis with high-dose bolus tissue plasminogen activator in iatrogenic arterial occlusion after femoral arterial catheterization

Cardiovascular and Interventional Radiology
Dimitrios K TsetisNicholas C Gourtsoyiannis

Abstract

To assess the efficacy of percutaneous local thrombolysis with high-dose bolus recombinant tissue plasminogen activator (rt-PA) in patients with acute limb ischemia due to arterial thrombosis after cardiac catheterization. We treated eight patients (7 men; mean age 56 years) with thrombotic occlusion of both the common femoral artery (CFA) and external iliac artery (EIA) in six patients and of the CFA only in two patients. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 Fr end-hole catheter and subsequently two additional boluses of 5 mg rt-PA were given through a catheter with multiple side-holes. In case of a significant amount of residual thrombus, a continuous infusion of 2.5 mg/hr of rt-PA was started. Successful lysis was achieved in all patients. The mean duration of lysis was 2 hr 41 min. The mean total amount of rt-PA delivered was 23.16 mg. In four patients unmasked flow-limited dissections confined to the CFA were managed by prolonged balloon dilatation, while in the remaining four patients with extension of the dissection to the external iliac artery one or two Easy Wallstents were implanted. There was prompt relief of lower limb ischemic symptoms and signs in all patients. Two groin hemat...Continue Reading

Citations

Apr 12, 2011·Pediatric Cardiology·Philip T ThrushRalf J Holzer
Feb 18, 2010·Cardiovascular and Interventional Radiology·Dimitrios Tsetis
Feb 5, 2013·Current Treatment Options in Cardiovascular Medicine·Raghu KolluriShailesh Nandish
Dec 1, 2008·Seminars in Interventional Radiology·Brian Funaki
Nov 20, 2013·Cardiovascular Intervention and Therapeutics·Budunur C SrinivasBabu Reddy
Dec 5, 2003·Journal of Vascular and Interventional Radiology : JVIR·Mahmood K RazaviLawrence V Hofmann
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Dec 24, 2005·Journal of Vascular and Interventional Radiology : JVIR·Hyun S KimMichael B Streiff
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Sep 2, 2005·Acta Radiologica·B OnalA Akkaya

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