Intra-arterial thrombolysis for the acutely ischaemic leg: experience in a district general hospital.

Intra-arterial thrombolytic therapy (IATT) is a recognized treatment for acute on chronic lower limb ischaemia due to thrombosis when duration of therapy will not compromise limb viability. In this prospective study at a district general hospital, 36 consecutive patients (mean age 73.6 +/- 1.7 years) with acute lower limb ischaemia, presenting as severe and worsening claudication or rest pain, underwent urgent IATT using streptokinase (n = 35) or tPA (n = 1). Thrombolysis was monitored by daily angiography. IATT was performed alone in 26 patients and in conjunction with angioplasty in a further 10 patients. Mean treatment duration was 2.27 + 0.25 days. The 30 day mortality was 11.1% Complications abbreviated IATT in 8.3%. The 30 day primary limb salvage rate for IATT +/- angioplasty was 44.4% (16/36). The mean ABPI pre IATT +/- angioplasty was 0.19 +/- 0.04(n = 35) compared with 0.52 +/- 0.08 after IATT +/- angioplasty (n = 31) (P < 0.011). Eight patients without clinical benefit underwent salvage surgery with a secondary limb salvage rate of 61%. ABPI post-salvage surgery was similarly increased to 0.54 +/- 0.17. Intra-arterial thrombolytic therapy for the acutely ischaemic leg in a district general hospital, may contribute to limb salvage.