CardioVascular and Interventional Radiology

, Volume 35, Issue 2, pp 279–285 | Cite as

Initial Results of Catheter-Directed Ultrasound-Accelerated Thrombolysis for Thromboembolic Obstructions of the Aortofemoral Arteries: A Feasibility Study

  • A. Marjolein Schrijver
  • Michel M. P. J. Reijnen
  • Jacques A. van Oostayen
  • Arjan W. J. Hoksbergen
  • Rutger J. Lely
  • Marc van Leersum
  • Jean-Paul P. M. de Vries
Clinical Investigation
First Online:
Received:
Accepted:

Abstract

Purpose

This article reports the 30-day technical and clinical outcome of ultrasound (US)-accelerated thrombolysis in patients with aortofemoral arterial thromboembolic obstructions.

Methods

A prospective cohort study was conducted from December 2008 to December 2009 of patients who were treated with US-accelerated thrombolysis for thromboembolic obstructions of aortofemoral arteries or bypasses. Urokinase was infused in a dosage of 100,000 IU per hour. Twice daily, a control angiography was performed. Thirty-day follow-up consisted of duplex scanning, combined with magnetic resonance angiography.

Results

The study included 21 consecutive patients (20 men; median age, 66 (range, 52–80) years) with 24% artery versus 76% bypass occlusions. Median duration of symptoms was 11 (range, 7–140) days. Median occlusion length was 32 (range, 6–80) cm. In 20 patients (95%), an US-accelerated thrombolysis catheter could be successfully placed. In one patient, placement of an US-accelerated thrombolysis catheter was technically not feasible, and therefore a standard catheter was placed. Median thrombolysis time was 26.5 (range, 8.5–72) hours. Complete thrombolysis (>95% lysis of thrombus) was achieved in 20 patients; in 9 patients within 24 hours. Median ankle-brachial index (ABI) increased from 0.28 (range, 0–0.85) to 0.91 (range, 0.58–1.35). One patient had a thromboembolic complication and needed surgical intervention. No hemorrhagic complications, and no deaths occurred. At 30-day follow-up, 17 of 21 patients (81%) had a patent artery or bypass.

Conclusions

This feasibility study showed a high technical success rate of US-accelerated thrombolysis for aortofemoral arterial obstructions. US-accelerated thrombolysis led to complete lysis within 24 hours in almost half of patients, with a low 30-day major complication rate.

Keywords

Peripheral arterial disease Thrombolysis 
This is a preview of subscription content, log in to check access.

Notes

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Yeager RA, Moneta GL, Taylor LM Jr, Hamre DW, McConnell DB, Porter JM (1992) Surgical management of severe acute lower extremity ischemia. J Vasc Surg 15(2):385–391PubMedCrossRefGoogle Scholar
  2. 2.
    Gardiner GA Jr, Harrington DP, Koltun W, Whittemore A, Mannick JA, Levin DC (1989) Salvage of occluded arterial bypass grafts by means of thrombolysis. J Vasc Surg 9(3):426–431PubMedGoogle Scholar
  3. 3.
    Graor RA, Risius B, Young JR, Lucas FV, Beven EG, Hertzer NR, Krajewski LP, O’Hara PJ, Olin J, Ruschhaupt WF (1988) Thrombolysis of peripheral arterial bypass grafts: surgical thrombectomy compared with thrombolysis. A preliminary report. J Vasc Surg 7(2):347–355PubMedGoogle Scholar
  4. 4.
    The STILE Trial (1994) Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. Ann Surg 220(3):251–266CrossRefGoogle Scholar
  5. 5.
    Ouriel K, Veith FJ, Sasahara AA (1998) A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med 338(16):1105–1111PubMedCrossRefGoogle Scholar
  6. 6.
    Berridge DC, Kessel DO, Robertson I (2009) Surgery versus thrombolysis for initial management of acute limb ischaemia [systematic review]. Cochrane Database of Systematic Reviews 1(1)Google Scholar
  7. 7.
    Francis CW, Suchkova VN (2001) Ultrasound and thrombolysis. Vasc Med 6(3):181–187PubMedCrossRefGoogle Scholar
  8. 8.
    Siegel RJ, Fishbein MC, Forrester J, Moore K, DeCastro E, Daykhovsky L, Don Michael TA (1988) Ultrasonic plaque ablation. A new method for recanalization of partially or totally occluded arteries. Circulation 78(6):1443–1448PubMedCrossRefGoogle Scholar
  9. 9.
    Steffen W, Fishbein MC, Luo H, Lee DY, Nita H, Cumberland DC, Tabak SW, Carbonne M, Maurer G, Siegel RJ (1994) High-intensity, low-frequency catheter-delivered ultrasound dissolution of occlusive coronary artery thrombi: an in vitro and in vivo study. J Am Coll Cardiol 24(6):1571–1579PubMedCrossRefGoogle Scholar
  10. 10.
    Luo H, Nishioka T, Fishbein MC, Cercek B, Forrester JS, Kim CJ, Berglund H, Siegel RJ (1996) Transcutaneous ultrasound augments lysis of arterial thrombi in vivo. Circulation 94(4):775–778PubMedGoogle Scholar
  11. 11.
    Riggs PN, Francis CW, Bartos SR, Penney DP (1997) Ultrasound enhancement of rabbit femoral artery thrombolysis. Cardiovasc Surg 5(2):201–207PubMedCrossRefGoogle Scholar
  12. 12.
    Atar S, Luo H, Nagai T, Sahm RA, Fishbein MC, Siegel RJ (2001) Arterial thrombus dissolution in vivo using a transducer-tipped, high-frequency ultrasound catheter and local low-dose urokinase delivery. J Endovasc Ther 8(3):282–290PubMedCrossRefGoogle Scholar
  13. 13.
    Braaten JV, Goss RA, Francis CW (1997) Ultrasound reversibly disaggregates fibrin fibers. Thromb Haemost 78(3):1063–1068PubMedGoogle Scholar
  14. 14.
    Francis CW, Onundarson PT, Carstensen EL, Blinc A, Meltzer RS, Schwarz K, Marder VJ (1992) Enhancement of fibrinolysis in vitro by ultrasound. J Clin Invest 90(5):2063–2068PubMedCrossRefGoogle Scholar
  15. 15.
    Harpaz D, Chen X, Francis CW, Marder VJ, Meltzer RS (1993) Ultrasound enhancement of thrombolysis and reperfusion in vitro. J Am Coll Cardiol 21(6):1507–1511PubMedCrossRefGoogle Scholar
  16. 16.
    Lauer CG, Burge R, Tang DB, Bass BG, Gomez ER, Alving BM (1992) Effect of ultrasound on tissue-type plasminogen activator-induced thrombolysis. Circulation 86(4):1257–1264PubMedGoogle Scholar
  17. 17.
    Siddiqi F, Odrljin TM, Fay PJ, Cox C, Francis CW (1998) Binding of tissue-plasminogen activator to fibrin: effect of ultrasound. Blood 91(6):2019–2025PubMedGoogle Scholar
  18. 18.
    Tachibana K, Tachibana S (1997) Prototype therapeutic ultrasound emitting catheter for accelerating thrombolysis. J Ultrasound Med 16(8):529–535PubMedGoogle Scholar
  19. 19.
    The Interventional Management of Stroke (IMS) II Study. Stroke 38(7):2127–2135 (2007)Google Scholar
  20. 20.
    Mahon BR, Nesbit GM, Barnwell SL, Clark W, Marotta TR, Weill A, Teal PA, Qureshi AI (2003) North American clinical experience with the EKOS MicroLysUS infusion catheter for the treatment of embolic stroke. AJNR Am J Neuroradiol 24(3):534–538PubMedGoogle Scholar
  21. 21.
    Motarjeme A (2007) Ultrasound-enhanced thrombolysis. J Endovasc Ther 14(2):251–256PubMedCrossRefGoogle Scholar
  22. 22.
    Parikh S, Motarjeme A, McNamara T, Raabe R, Hagspiel K, Benenati JF, Sterling K, Comerota A (2008) Ultrasound-accelerated thrombolysis for the treatment of deep vein thrombosis: initial clinical experience. J Vasc Interv Radiol 19(4):521–528PubMedCrossRefGoogle Scholar
  23. 23.
    Raabe RA (2006) Ultrasound facilitated thrombolysis in treating DVT. Rapid and complete clot clearance using EKOS Lysus System offers promising treatment for DVT. Endovasc Today 4:75–79Google Scholar
  24. 24.
    Wissgott C, Richter A, Kamusella P, Steinkamp HJ (2007) Treatment of critical limb ischemia using ultrasound-enhanced thrombolysis (PARES Trial): final results. J Endovasc Ther 14(4):438–443PubMedCrossRefGoogle Scholar
  25. 25.
    Wissgott C, Kamusella P, Richter A, Klein-Weigel P, Schink T, Steinkamp HJ (2008) Treatment of acute femoropopliteal bypass graft occlusion: comparison of mechanical rotational thrombectomy with ultrasound-enhanced lysis. Rofo 180(6):547–552PubMedCrossRefGoogle Scholar
  26. 26.
    Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14(9 Pt 2):S199–S202PubMedCrossRefGoogle Scholar
  27. 27.
    Francis CW (2001) Ultrasound-enhanced thrombolysis. Echocardiography 18(3):239–246PubMedCrossRefGoogle Scholar
  28. 28.
    Atar S, Luo H, Birnbaum Y, Hansmann D, Siegel RJ (2001) The use of transducer-tipped ultrasound catheter for recanalization of thrombotic arterial occlusions. Echocardiography 18(3):233–237PubMedCrossRefGoogle Scholar
  29. 29.
    Loren M, Garcia Frade LJ, Torrado MC, Navarro JL (1989) Thrombus age and tissue plasminogen activator mediated thrombolysis in rats. Thromb Res 56(1):67–75PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011

Authors and Affiliations

  • A. Marjolein Schrijver
    • 1
  • Michel M. P. J. Reijnen
    • 2
  • Jacques A. van Oostayen
    • 3
  • Arjan W. J. Hoksbergen
    • 4
  • Rutger J. Lely
    • 5
  • Marc van Leersum
    • 6
  • Jean-Paul P. M. de Vries
    • 1
  1. 1.Department of Vascular SurgerySt. Antonius HospitalNieuwegeinThe Netherlands
  2. 2.Department of Vascular SurgeryRijnstate HospitalArnhemThe Netherlands
  3. 3.Department of Interventional RadiologyRijnstate HospitalArnhemThe Netherlands
  4. 4.Department of Vascular SurgeryFree University Medical CenterAmsterdamThe Netherlands
  5. 5.Department of Interventional RadiologyFree University Medical CenterAmsterdamThe Netherlands
  6. 6.Department of Interventional RadiologySt. Antonius HospitalNieuwegeinThe Netherlands

Personalised recommendations