Outcomes of Intra-operative Thrombolysis in Late Acute Arterial Embolism of the Lower Limb in a Cohort of Patients in Thailand
Chanean Ruangsetakit MD*, Vipavee Niyomnaitham MD*, Khamin Chinsakchai MD*, Chumpol Wongwanit MD*, Nuttawut Sermsathanasawadi MD, PhD*, Pramook Mutirangura MD*, Suteekhanit Hahtapornsawan MD*
Affiliation : * Vascular Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Patients with acute arterial embolism of the lower limb who present early and are treated promptly. Surgical
embolectomy is successful more than 90%. Patients with late presentation of acute arterial embolism of the lower limb with
immediate threatened severity (Rutherford grade IIB), need emergency revascularization. Surgical embolectomy without
adjunctive treatment is successful in only 60 to 70%. The patients need to get intraoperative thrombolysis to improve the
outcome of treatment.
Objective : We sought to establish the outcomes of Thai patients undergoing intra-operative thrombolysis combined with
surgical embolectomy for late acute arterial embolism of the lower limb who presented with immediately threatened severity
(Rutherford grade IIB). We aimed to use our findings to inform the development of new treatment guidelines and protocols in
Thailand.
Material and Method: We reviewed the records of 37 late-presenting patients with immediately threatened severity lower
limb ischemia who underwent embolectomy with intra-operative thrombolysis between January 1995 and December 2014
under the care of the Department of Vascular Surgery, Siriraj Hospital, Bangkok, Thailand. We recorded patients’ demographic
data, intra-operative data, postoperative complications, limb salvageability rate and mortality rate 1 month and 1 year after
treatment.
Results : The median time that elapsed between symptom onset and revascularization was 7 day (range 1 to 120 day). Twenty-
two patients (59.5%) were treated with streptokinase, with the remainder treated with recombinant tissue plasminogen
activator. The limb salvageability rate within 1 month and 1 year showed the same results (89.2%). The mortality rate within
1 month was 5.4% but 10.8% at 1 year. The recovery of four patients was complicated by hemorrhage, seven by re-
thrombosis, three by wound hematoma, one by postoperative myocardial infarction, one by surgical site infection and one by
gangrene.
Conclusion : Intra-operative thrombolysis is a safe and effective adjunct to embolectomy that increases limb salvageability in
Thai patients with late acute arterial embolism of the lower limb.
Keywords : acute arterial occlusion, embolism, lower limb ischemia, thrombolysis
