Abstract
Purpose:
To explore the potential benefits from heating recombinant tissue plasminogen activator (rtPA) before catheter-directed thrombolysis in patients with lower-limb ischemia of <30 days' duration.
Methods:
Over a 2-year period, 34 patients (26 men; mean age 63.5 years, range 39–80) with 10 iliac and 24 infrainguinal arterial occlusions (5 embolic and 29 thrombotic) were treated with two 5-mg boluses of rtPA injected into the proximal clot, followed by 2 additional 5-mg boluses of rtPA. In the first 18 patients (group A), room temperature rtPA was administered, whereas in the last 16 patients (group B), the rtPA boluses were heated to 38°C for 30 minutes before injection. Residual thrombus was treated with a continuous infusion of 2.5 mg/h of rtPA for 4 hours then at a reduced dose (1 mg/h).
Results:
Successful thrombolysis was achieved in 28 (82%) arteries. Unmasked lesions were treated with balloon angioplasty/stenting in 17 cases and with surgery in 4. One fatal retroperitoneal hematoma occurred in group A. Heating the rtPA did not significantly alter the outcome of thrombolysis. However, a statistically significant reduction in the total rtPA dose was observed in group B (24.28 mg versus 27.9 mg in group A, p = 0.05), as well as quicker lysis (2 hours, 42 minutes versus 6 hours, 12 minutes in group A, p = 0.001). There was no statistical difference in the amputation-free survival at 30 days between the groups.
Conclusions:
In patients with acute or subacute lower limb ischemia treated with catheter-directed thrombolysis, heating the rtPA results in faster lysis with a considerable reduction in the total dose of the lytic agent.
Keywords
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