%0 Journal Article
%T Contemporary trends and outcomes of thrombolytic therapy for acute lower extremity ischemia
%A Jonathan Bath
%A Ryan J Kim
%A Todd R Vogel
%A Viktor Y Dombrovskiy
%J Vascular
%@ 1708-539X
%D 2019
%R 10.1177/1708538118797782
%X Acute limb ischemia is a common vascular emergency requiring immediate intervention. Thrombolysis has been widely utilized for acute limb ischemia; the purpose of this study is to analyze contemporary trends, outcomes and complications of thrombolysis for acute limb ischemia. Patients were identified from the Nationwide Inpatient Sample (2003每2013) using ICD-9. Patients undergoing emergency thrombolysis for acute limb ischemia were evaluated. Three groups were analyzed: thrombolysis alone, thrombolysis and endovascular procedure (T+ENDO), and failed thrombolysis requiring open surgery (T+OPEN). A total of 162,240 patients with acute limb ischemia were estimated: 33,615 patients (20.7%) underwent thrombolysis as the initial treatment. Mean age was 66.2ˋ㊣ˋ34.9 years with 54% male. The utilization of thrombolysis increased significantly during the study period (16.8每24.2%, pˋ<ˋ0.0001). The most common group was thrombolysis and endovascular procedure (40.7%), followed by thrombolysis alone (34.1%), and T+OPEN (25.2%). Thrombolysis and endovascular procedure increased significantly over time (31.6每47.8%, pˋ<ˋ0.0001) whereas thrombolysis alone and T+OPEN significantly decreased (39.6每28.6% and 28.7每23.6%, respectively, pˋ<ˋ0.0001). Overall mortality was 4.9%; thrombolysis and endovascular procedure compared to thrombolysis alone and T-OPEN had a lower mortality rate (3.2% vs. 6.1% and 5.9%, pˋ<ˋ0001). The overall stroke rate was 1.9%; thrombolysis alone had the highest stroke rate (3.0%, pˋ<ˋ0.0001) with thrombolysis and endovascular procedure the lowest (1.2%) and T+OPEN 1.7%. The highest amputation rate was T+OPEN (11.6%, pˋ<ˋ0.001) compared to thrombolysis and endovascular procedure (5.1%) and thrombolysis alone (5.3%). T+OPEN had the highest incidence of cardiac (5.5%), respiratory (7.3%) and renal complications (12.5%), pneumonia (4.0%), and fasciotomy (16.8%) (all pˋ<ˋ0.0001). Thrombolysis remains an effective treatment for acute limb ischemia with increased utilization over time. There was a significant increase in thrombolysis and endovascular procedure leading to improved outcomes. Thrombolysis alone carried the highest mortality and stroke rate, with T+OPEN associated with the highest amputation and complications. Although thrombolysis is effective, 25% of patients required an open procedure suggesting that patient selection for thrombolysis first instead of open surgery continues to be a clinical challenge
%K Acute limb ischemia
%K acute lower extremity ischemia
%K thrombolysis
%U https://journals.sagepub.com/doi/full/10.1177/1708538118797782