Use of second time window principle for thrombolysis in chronic lower limb ischemia

Objective To evaluate the safety and efficacy of preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty in treating chronic occlusive arterial disorders of lower extremities under the second time window principle for thrombolysis. Methods From Jan 2001 to Dec 2014, preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty was performed in 206 patients with chronic occlusive arterial disorders of lower extremities.All the patients had a history of chronic ischemia of lower limb for an average of (20±9) months (3-60 months). Ankle-brachial index (ABI) was 0.00-0.65 with a mean of (0.33±0.22). Results The mean time of thrombolysis was 72 hours (within a range of 24-120 h). The D-dimer level multiplied next day after thrombolysis . The occluded length of the diseased arteries before the treatment was 60-180 mm, with a mean of (90±27) mm. After catheter-directed thrombolysis, the occluded length decreased to 20-60 mm [mean of (40±15) mm]. Thrombolysis was effective in 192 patients (92%). Endovascular angioplasty was successfully completed in all patients after thrombolysis therapy. Postoperative ABI was 0.64-1.0 [mean of (0.86±0.11)]. During the perioperative period no complications nor death occurred. Conclusions Under the guidance of the second time window principle for thrombolysis, preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty is an effective and safe treatment for chronic occlusive arterial disorders of the lower extremities. Key words: Arterial occlusive disease; Thrombolytic therapy