Schernthaner Melanie B, Samuels Shaun, Biegler Peter, Benenati James F, Uthoff Heiko
Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 North Kendall Drive, Miami, FL 33176; Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University Vienna, Vienna, Austria.
Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 North Kendall Drive, Miami, FL 33176.
J Vasc Interv Radiol. 2014 Aug;25(8):1149-56; quiz 1157. doi: 10.1016/j.jvir.2014.03.015. Epub 2014 Jun 3.
To compare the safety and efficacy of ultrasound-accelerated thrombolysis (UAT) and standard catheter-directed thrombolysis (CDT) in patients with acute and subacute limb ischemia.
Medical records of all patients treated with thrombolysis for acute and subacute limb ischemia between August 2005 and January 2012 were reviewed. Coprimary (increase in ankle-brachial index, degree of lysis) and secondary endpoints (technical success, distal embolization, bleeding complications, need for additional interventions) were assessed. UAT was performed in 75 patients, and CDT was performed in 27 patients. Patients' baseline demographic and clinical parameters and procedure details, including lytic drug infusion rate (P = .704 and P = .987), total infusion time (P = .787 and P = .377), and use of adjunctive procedures (P = .457), did not differ significantly between the two groups.
Complete lysis was achieved in 72.0% (UAT) and 63.0% (CDT) of patients (P = .542); hemodynamic success was achieved in 91.8% (UAT) and 92.3% (CDT) (P = .956). Overall major and minor bleeding complications were observed in 6.9% (UAT) and 3.9% (CDT) of patients. Major (P = .075) and minor (P = .276) bleeding independently did not differ between UAT and CDT. Major and minor bleeding combined was lower: 6.7% (UAT) versus 22.2% (CDT) (P = .025). Overall target vessel patency after 8.0 months (range, 1.5-20.5 mo) was 73.5%; target vessel patency for UAT was 75.9% versus 64.3% for CDT (P = .379). Median long-term survival was not significantly different between UAT and CDT: 3.6 years (range, 2.42-5.33 y) versus 1.8 years (range, 1.33-4.92 y) (P = .061).
Both UAT and CDT are safe and efficient treatment modalities for patients with acute and subacute limb ischemia. The observed lower risk of total bleeding for UAT versus CDT may warrant prospective comparative trials.
比较超声加速溶栓（UAT）与标准导管定向溶栓（CDT）治疗急性和亚急性肢体缺血患者的安全性和有效性。
回顾2005年8月至2012年1月期间所有接受溶栓治疗急性和亚急性肢体缺血患者的病历。评估共同主要终点（踝肱指数增加、溶栓程度）和次要终点（技术成功、远端栓塞、出血并发症、额外干预需求）。75例患者接受UAT治疗，27例患者接受CDT治疗。两组患者的基线人口统计学和临床参数以及手术细节，包括溶栓药物输注速率（P = 0.704和P = 0.987）、总输注时间（P = 0.787和P = 0.377）以及辅助手术的使用（P = 0.457），差异均无统计学意义。
UAT组和CDT组分别有72.0%和63.0%的患者实现完全溶栓（P = 0.542）；血流动力学成功的患者分别为91.8%（UAT）和92.3%（CDT）（P = 0.956）。UAT组和CDT组分别有6.9%和3.9%的患者出现总体主要和次要出血并发症。UAT组和CDT组的主要出血（P = 0.075）和次要出血（P = 0.276）差异均无统计学意义。主要和次要出血合并发生率较低：UAT组为6.7%，CDT组为22.2%（P = 0.025）。8.0个月（范围1.5 - 20.5个月）后的总体靶血管通畅率为73.5%；UAT组的靶血管通畅率为75.9%，CDT组为64.3%（P = 0.379）。UAT组和CDT组的中位长期生存率差异无统计学意义：3.6年（范围2.42 - 5.33年）对1.8年（范围1.33 - 4.92年）（P = 0.061）。
UAT和CDT都是治疗急性和亚急性肢体缺血患者的安全有效治疗方式。观察到UAT与CDT相比总出血风险较低，这可能值得进行前瞻性比较试验。
