The American Journal of Surgery
Volume 170, Issue 2 , Pages 131-135, August 1995

Computerized angiographic analysis of the outcome of peripheral thrombolysis☆☆☆★

  • Bruce D. Braithwaite, MA

      Affiliations

    • Department of Vascular Surgery, University of California, Los Angeles, California, USA
    • Department of Surgery, Gloucestershire Royal Hospital, Gloucester, United Kingdom
    • ,
  • Pavel V. Petrik, MD

      Affiliations

    • Department of Vascular Surgery, University of California, Los Angeles, California, USA
    • ,
  • Alistair W.S. Ritchie, MD, FRCSE

      Affiliations

    • Department of Surgery, Gloucestershire Royal Hospital, Gloucester, United Kingdom
    • ,
  • Jonothan J. Earnshaw, DM, FRCS

      Affiliations

    • Corresponding Author InformationRequests for reprints should be addressed to Mr. J.J. Earnshaw, Gloucestershire Royal Hospital, Gloucester, United Kingdom GL1 3NN.
    • Department of Surgery, Gloucestershire Royal Hospital, Gloucester, United Kingdom

Abstract 

Background: Catheter-directed peripheral thrombolysis is used increasingly for the management of acute limb ischemia. The comparison of different agents and techniques has proven difficult because of the variations in patient presentation, vessel involvement, and treatment methods.

Methods: A computerized database in which angiographic information is stored on computerized arterial maps has been designed to record details of thrombolysis.

Results: A total of 201 patients who presented with rest pain were recorded on the database, and their angiograms were analyzed. There were 123 native-vessel and 78 graft occlusions. Immediate success of lysis and 30-day outcome were not dependent on the site of the occlusion. If an underlying stenosis was revealed, limb salvage rates were significantly greater than when none was found (82% versus 58%, P <0.01). The presence of at least 1 run-off vessel increased limb salvage rates by 30% (P <0.001). If more than 5 arterial segments were occluded on the prelysis angiogram, limb salvage was worse than if there were fewer than 5 (57% versus 85%, P <0.0001). For grafts, less than 5 segments of occlusion led to limb salvage rates of 90%, and more than 5 segments of occlusion led to rates of 72% (P = 0.07).

Conclusions: This simple and user-friendly system of computerized angiographic analysis will enable detailed examination of thrombolytic practice and assist in the prediction of success.

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☆ Presented on behalf of the British Thrombolysis Study Group (Dr. A. Al-Kutoubi, Mr. J. Beard, Mr. D. Berridge, Dr. P.A. Birch, Dr. T. Buckenham, Mr. J. Dormandy, Dr. P. Gaines, Mr. R. Galland, Mr. B. Heather, Mr. G. Hamilton, Prof. T. McNamara, Prof. W. Moore, Dr. A. Platts, Prof. W. Quinones-Baldrich, Dr. P. Torrie, Mr. J. Wolfe).

☆☆ Mr. Braithwaite is supported by a grant from Boehringer Ingelheim, Bracknell, United Kingdom. The National Audit of Thrombolysis and Acute Limb Ischaemia (NATALI) Database is supported by a grant from the Department of Health.

★ Presented at the 23rd Annual Meeting of The Society for Clinical Vascular Surgery, Fort Lauderdale, Florida, March 22–26, 1995.

PII: S0002-9610(99)80271-2

The American Journal of Surgery
Volume 170, Issue 2 , Pages 131-135, August 1995

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