Thrombolysis for acute arterial occlusion

Introduction: Acute leg ischemia is one of the most challenging and dangerous conditions in vascular surgical practice and carries a high risk of amputation and death when left untreated. This article provides an overview of the currently held opinions on the role of catheter-based thrombolytic therapy in patients with acute leg ischemia. Methods: A systematic review of literature from 1980 to 2009 was performed. The literature analyzed included randomized trials, large single-center case series, and review articles. Results: Three large randomized trials and 14 review articles were identified. Pharmacologic aspects and the results of thrombolytic therapy, as well as indications, contraindications, and complications are described. Conclusions: Catheter-directed thrombolysis can be considered a complementary and not a competing technology with surgical or percutaneous revascularization, with an acceptably low complication rate. © 2010 Society for Vascular Surgery.