Intra-arterial Thrombolysis for Extremity Frostbite Decreases Digital Amputation Rates and Hospital Length of Stay

• Published in: Cardiovascular and interventional radiology 2017-12, Vol.40 (12), p.1824-1831
• Main Authors: Patel, Nishant, Srinivasa, Dhivya R., Srinivasa, Ravi N., Gemmete, Joseph J., Krishnamurthy, Venkat, Dasika, Narasimham, Reddy, Shilpa N., Osher, Matthew L., Sears, Erika D., Chick, Jeffrey Forris Beecham
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Amputation; Amputation - statistics & numerical data; Cardiology; Clinical Investigation; Complications; Digits; Extremities; Female; Fingers - blood supply; Fingers - surgery; Frostbite; Frostbite - drug therapy; Heparin; Humans; Imaging; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Nitroglycerin; Nuclear Medicine; Patients; Radiology; Risk management; t-Plasminogen activator; Thrombolysis; Thrombolytic Therapy - methods; Toes - blood supply; Toes - surgery; Treatment Outcome; Ultrasound; Young Adult
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-017-1729-7

Purpose To report outcomes of intra-arterial thrombolysis versus non-thrombolytic management of severe frostbite with respect to digital amputation rates and hospital length of stay (LOS). Materials and Methods Seventeen patients with severe frostbite were identified from 2000 to 2017. Eight (47%) patients with mean age of 40 years underwent intra-arterial thrombolysis and served as the treatment group. Nine (53%) patients with mean age of 53 years received non-thrombolytic management and served as the control group. 2/8 (25%) treatment and 3/9 (33%) control patients had underlying vascular comorbidities ( p  = 0.25). Number of digits at risk, duration of thrombolysis, thrombolytic agents used, digits amputated, hospital LOS, and complications were recorded. Results Seven upper and nine lower extremities for a total of 80 digits were at risk in the treatment cohort. Eight upper and 12 lower extremities for a total of 100 digits were at risk in the control group. Mean duration of thrombolysis was 26 h. All treatment patients received tissue plasminogen activator in addition to systemic heparin. 4/16 (25%) limbs received intra-arterial alprostadil, 2/16 (13%) received nitroglycerin, and 2/16 (13%) received nicardipine. 12/80 (15%) treatment digits and 77/100 (77%) control digits required amputation ( p  = 0.003). Average hospital LOS was 14 days in the treatment group and 38 days in the control group ( p  = 0.011). No major complications occurred in the treatment group; however, 2/9 (22%) patients in the control group required extended hospitalizations secondary to amputation complications. Conclusions Intra-arterial thrombolysis reduces digital amputation rates and hospital LOS in the setting of severe frostbite.