Ultrasound-accelerated thrombolysis for lower extremity ischemia: Multicenter experience and literature review

A. M. Schrijver, J. A. Vos, A. W.J. Hoksbergen, B. Fioole, W. M. Fritschy, R. G. Hulsebos, S. C. De Jong, M. M.P.J. Reijnen, J. P.P.M. De Vries

Research output: Contribution to journalArticleAcademicpeer-review

21 Citations (Scopus)

Abstract

Aim. This study evaluates the short-term outcome of ultrasound-accelerated thrombolysis in patients with lower extremity ischemia caused by thromboembolic occlusions. Methods. A retrospective cohort study was conducted from December 2008 to May 2011 of 57 patients (42 men; median age, 66±11 years) undergoing 62 episodes of ultrasound-accelerated thrombolysis for thromboembolic arterial occlusions of the lower extremities. The EKOS EndoWave System (EKOS Corporation, Bothell, WA, USA) was combined with urokinase (100000 IU/hour). Thirty-day and 6-month follow-up consisted of clinical evaluation, and Duplex scan or magnetic resonance angiography of the treated extremity. Results. Initial technical success was 97%, radiologic success was 82%, and overall clinical success was 77%. Median thrombolysis time was 21 hours (IQR, 15-24). In 38 of 51 procedures with successful lysis (75%) complete lysis was achieved within 24 hours. Major hemorrhage occurred in 2 procedures (3%), and distal embolization in 2 procedures (3%). During the initial hospitalization, the major amputation rate was 8% (N.=5) and the mortality rate was 2% (N.=1). The 30-day patency rate was 81%, without additional mortality. During a median 6-month (range, 2-14) followup, 9 reinterventions were performed. Two patients underwent major amputation and 3 patients died; because of malignancy (N.=2) and stroke (N.=1). Conclusion. Initial success rates of ultrasound-accelerated thrombolysis are high and complication rate is low. However, reintervention rate during short-term follow-up for recurrent ischemia is substantial. Results from a randomized controlled trial comparing ultrasound-accelerated thrombolysis with standard thrombolysis for lower extremity ischemia (DUET, Current Controlled Trials, ISRCTN72676102) are eagerly awaited.

Original languageEnglish
Pages (from-to)467-476
Number of pages10
JournalJournal of Cardiovascular Surgery
Volume52
Issue number4
Publication statusPublished - 1 Aug 2011
Externally publishedYes

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Lower Extremity
Ischemia
Amputation
Mortality
Magnetic Resonance Angiography
Urokinase-Type Plasminogen Activator
Hospitalization
Cohort Studies
Extremities
Randomized Controlled Trials
Retrospective Studies
Stroke
Hemorrhage
Neoplasms

Keywords

  • Ischemia
  • Lower extremity
  • Peripheral arterial disease
  • Thrombolytic therapy

Cite this

Schrijver, A. M., Vos, J. A., Hoksbergen, A. W. J., Fioole, B., Fritschy, W. M., Hulsebos, R. G., ... De Vries, J. P. P. M. (2011). Ultrasound-accelerated thrombolysis for lower extremity ischemia: Multicenter experience and literature review. Journal of Cardiovascular Surgery, 52(4), 467-476.
Schrijver, A. M. ; Vos, J. A. ; Hoksbergen, A. W.J. ; Fioole, B. ; Fritschy, W. M. ; Hulsebos, R. G. ; De Jong, S. C. ; Reijnen, M. M.P.J. ; De Vries, J. P.P.M. / Ultrasound-accelerated thrombolysis for lower extremity ischemia : Multicenter experience and literature review. In: Journal of Cardiovascular Surgery. 2011 ; Vol. 52, No. 4. pp. 467-476.
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Schrijver, AM, Vos, JA, Hoksbergen, AWJ, Fioole, B, Fritschy, WM, Hulsebos, RG, De Jong, SC, Reijnen, MMPJ & De Vries, JPPM 2011, 'Ultrasound-accelerated thrombolysis for lower extremity ischemia: Multicenter experience and literature review' Journal of Cardiovascular Surgery, vol. 52, no. 4, pp. 467-476.

Ultrasound-accelerated thrombolysis for lower extremity ischemia : Multicenter experience and literature review. / Schrijver, A. M.; Vos, J. A.; Hoksbergen, A. W.J.; Fioole, B.; Fritschy, W. M.; Hulsebos, R. G.; De Jong, S. C.; Reijnen, M. M.P.J.; De Vries, J. P.P.M.

In: Journal of Cardiovascular Surgery, Vol. 52, No. 4, 01.08.2011, p. 467-476.

Research output: Contribution to journalArticleAcademicpeer-review

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AU - Schrijver, A. M.

AU - Vos, J. A.

AU - Hoksbergen, A. W.J.

AU - Fioole, B.

AU - Fritschy, W. M.

AU - Hulsebos, R. G.

AU - De Jong, S. C.

AU - Reijnen, M. M.P.J.

AU - De Vries, J. P.P.M.

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N2 - Aim. This study evaluates the short-term outcome of ultrasound-accelerated thrombolysis in patients with lower extremity ischemia caused by thromboembolic occlusions. Methods. A retrospective cohort study was conducted from December 2008 to May 2011 of 57 patients (42 men; median age, 66±11 years) undergoing 62 episodes of ultrasound-accelerated thrombolysis for thromboembolic arterial occlusions of the lower extremities. The EKOS EndoWave System (EKOS Corporation, Bothell, WA, USA) was combined with urokinase (100000 IU/hour). Thirty-day and 6-month follow-up consisted of clinical evaluation, and Duplex scan or magnetic resonance angiography of the treated extremity. Results. Initial technical success was 97%, radiologic success was 82%, and overall clinical success was 77%. Median thrombolysis time was 21 hours (IQR, 15-24). In 38 of 51 procedures with successful lysis (75%) complete lysis was achieved within 24 hours. Major hemorrhage occurred in 2 procedures (3%), and distal embolization in 2 procedures (3%). During the initial hospitalization, the major amputation rate was 8% (N.=5) and the mortality rate was 2% (N.=1). The 30-day patency rate was 81%, without additional mortality. During a median 6-month (range, 2-14) followup, 9 reinterventions were performed. Two patients underwent major amputation and 3 patients died; because of malignancy (N.=2) and stroke (N.=1). Conclusion. Initial success rates of ultrasound-accelerated thrombolysis are high and complication rate is low. However, reintervention rate during short-term follow-up for recurrent ischemia is substantial. Results from a randomized controlled trial comparing ultrasound-accelerated thrombolysis with standard thrombolysis for lower extremity ischemia (DUET, Current Controlled Trials, ISRCTN72676102) are eagerly awaited.

AB - Aim. This study evaluates the short-term outcome of ultrasound-accelerated thrombolysis in patients with lower extremity ischemia caused by thromboembolic occlusions. Methods. A retrospective cohort study was conducted from December 2008 to May 2011 of 57 patients (42 men; median age, 66±11 years) undergoing 62 episodes of ultrasound-accelerated thrombolysis for thromboembolic arterial occlusions of the lower extremities. The EKOS EndoWave System (EKOS Corporation, Bothell, WA, USA) was combined with urokinase (100000 IU/hour). Thirty-day and 6-month follow-up consisted of clinical evaluation, and Duplex scan or magnetic resonance angiography of the treated extremity. Results. Initial technical success was 97%, radiologic success was 82%, and overall clinical success was 77%. Median thrombolysis time was 21 hours (IQR, 15-24). In 38 of 51 procedures with successful lysis (75%) complete lysis was achieved within 24 hours. Major hemorrhage occurred in 2 procedures (3%), and distal embolization in 2 procedures (3%). During the initial hospitalization, the major amputation rate was 8% (N.=5) and the mortality rate was 2% (N.=1). The 30-day patency rate was 81%, without additional mortality. During a median 6-month (range, 2-14) followup, 9 reinterventions were performed. Two patients underwent major amputation and 3 patients died; because of malignancy (N.=2) and stroke (N.=1). Conclusion. Initial success rates of ultrasound-accelerated thrombolysis are high and complication rate is low. However, reintervention rate during short-term follow-up for recurrent ischemia is substantial. Results from a randomized controlled trial comparing ultrasound-accelerated thrombolysis with standard thrombolysis for lower extremity ischemia (DUET, Current Controlled Trials, ISRCTN72676102) are eagerly awaited.

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Schrijver AM, Vos JA, Hoksbergen AWJ, Fioole B, Fritschy WM, Hulsebos RG et al. Ultrasound-accelerated thrombolysis for lower extremity ischemia: Multicenter experience and literature review. Journal of Cardiovascular Surgery. 2011 Aug 1;52(4):467-476.