Abstract

Acute lower limb ischemia associated with thrombotic events is a life-threatening condition. The treatment choice for this condition is catheter-directed thrombolysis considered the best treatment choice. An efficient and safe thrombolytic agent used is tissue plasminogen activator-like alteplase. Aim: To assess the efficacy and safety of percutaneous endovascular intervention in acute limb ischemia. Methods: In 72 subjects with acute thrombotic lower limb ischemia following thrombolysis limb salvage, clinical success, and technical success was assessed along with procedural complications. Results: Clinical success as limb salvage was seen in 87.5% (n=28) subjects with Rutherford classification II a and in 65% (n=26) subjects with Rutherford II b classification. Rutherford II b subjects were significantly lower in the success group (p=0.001). Risk factors include hyperlipidemia, ischemic heart disease, and hypertension. Diabetes mellitus and smoking were significantly higher in the failure group compared to the success group with p= 0.001. Morbidly obese and normal weight subjects were significantly higher in the failure group compared to the success group, whereas, overweight and obese subjects were higher in the success group than the failure group with p=0.007. Males and female subjects were statistically comparable in success and failure groups with p=0.16. The subjects in different age ranges were comparable between the success and failure groups with p=0.44 Conclusion: Catheter-directed thrombolysis utilizing alteplase is an effective and safe management modality for acute thrombotic lower limb ischemia. Also, better results were seen in subjects with no associated comorbidity, less severe clinical presentation, and low BMI.

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