Endovascular Treatment Strategy Using Catheter-Directed Thrombolysis, Percutaneous Aspiration Thromboembolectomy, and Angioplasty for Acute Upper Limb Ischemia

• Published in: Cardiovascular and interventional radiology 2017-07, Vol.40 (7), p.978-986
• Main Authors: Ueda, Tatsuo, Murata, Satoru, Miki, Izumi, Yasui, Daisuke, Sugihara, Fumie, Tajima, Hiroyuki, Morota, Tetsuro, Kumita, Shin-Ichiro
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Aneurysms; Angioplasty; Angioplasty - methods; Arm - blood supply; Cardiology; Cardiovascular system; Catheters; Cerebellum; Clinical Investigation; Combined Modality Therapy; Complications; Dosage; Embolectomy - methods; Endovascular Procedures - methods; Female; Hemorrhage; Humans; Imaging; Ischemia; Ischemia - therapy; Male; Medical instruments; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; Patients; Radiology; Success; Thrombectomy - methods; Thrombolysis; Thrombolytic drugs; Thrombolytic Therapy - methods; Treatment Outcome; U-Plasminogen activator; Ultrasound; Urokinase; Urokinase-Type Plasminogen Activator - therapeutic use
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-017-1599-z

Purpose To evaluate the usefulness and safety of endovascular treatments for acute upper limb ischemia (AULI) by using multiple techniques, and to compare catheter-directed thrombolysis (CDT) and percutaneous aspiration thromboembolectomy (PAT) as initial procedures. Materials and Methods The study included 18 patients (4 men and 14 women) with AULI, who underwent a total of 20 sessions of endovascular treatment using various endovascular techniques between January 2005 and April 2016. The patients were initially treated with CDT [ n  = 9, CDT-based group (C-G)], PAT [ n  = 6, PAT-based group (P-G)], or angioplasty ( n  = 3). In case of residual emboli, we performed additional endovascular techniques. We assessed technical success, clinical success, and complications. Additionally, we compared the urokinase dosage between the groups. Results The mean patient age was 74.4 years. Technical and clinical success was obtained in all patients. Among the 18 patients, 1 underwent CDT only, 2 underwent PAT only, 1 underwent angioplasty only, and 14 underwent multiple techniques. Two patients from the C-G experienced major complications (cerebellar hemorrhage 1; pseudo-aneurysm in a branch of the ulnar artery 1). The mean urokinase dosage was lower in the P-G than in the C-G (40,000 vs. 246,667 IU; Mann–Whitney U test, P  = 0.004). Conclusion Endovascular treatment is effective and safe for AULI. A combination of multiple endovascular techniques is important for successful treatment. PAT is suggested as an initial procedure among endovascular techniques, in terms of a lower dosage of urokinase and a lower complication rate. Level of Evidence IV, Case-control studies.