CardioVascular and Interventional Radiology

, Volume 40, Issue 7, pp 978–986 | Cite as

Endovascular Treatment Strategy Using Catheter-Directed Thrombolysis, Percutaneous Aspiration Thromboembolectomy, and Angioplasty for Acute Upper Limb Ischemia

  • Tatsuo UedaEmail author
  • Satoru Murata
  • Izumi Miki
  • Daisuke Yasui
  • Fumie Sugihara
  • Hiroyuki Tajima
  • Tetsuro Morota
  • Shin-Ichiro Kumita
Clinical Investigation



To evaluate the usefulness and safety of endovascular treatments for acute upper limb ischemia (AULI) by using multiple techniques, and to compare catheter-directed thrombolysis (CDT) and percutaneous aspiration thromboembolectomy (PAT) as initial procedures.

Materials and Methods

The study included 18 patients (4 men and 14 women) with AULI, who underwent a total of 20 sessions of endovascular treatment using various endovascular techniques between January 2005 and April 2016. The patients were initially treated with CDT [n = 9, CDT-based group (C-G)], PAT [n = 6, PAT-based group (P-G)], or angioplasty (n = 3). In case of residual emboli, we performed additional endovascular techniques. We assessed technical success, clinical success, and complications. Additionally, we compared the urokinase dosage between the groups.


The mean patient age was 74.4 years. Technical and clinical success was obtained in all patients. Among the 18 patients, 1 underwent CDT only, 2 underwent PAT only, 1 underwent angioplasty only, and 14 underwent multiple techniques. Two patients from the C-G experienced major complications (cerebellar hemorrhage 1; pseudo-aneurysm in a branch of the ulnar artery 1). The mean urokinase dosage was lower in the P-G than in the C-G (40,000 vs. 246,667 IU; Mann–Whitney U test, P = 0.004).


Endovascular treatment is effective and safe for AULI. A combination of multiple endovascular techniques is important for successful treatment. PAT is suggested as an initial procedure among endovascular techniques, in terms of a lower dosage of urokinase and a lower complication rate.

Level of Evidence

IV, Case-control studies.


Acute upper limb ischemia Endovascular treatment Catheter-directed thrombolysis Percutaneous aspiration thromboembolectomy 


Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in this study were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Declaration of Helsinki and its later amendments. This study did not include any animals.

Informed Consent

Informed consent was obtained from all individual participants included in this study.


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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2017

Authors and Affiliations

  1. 1.Department of RadiologyNippon Medical SchoolTokyoJapan
  2. 2.Department of Cardiovascular SurgeryNippon Medical SchoolTokyoJapan

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