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Intra-arterial Thrombolysis for Extremity Frostbite Decreases Digital Amputation Rates and Hospital Length of Stay

Abstract

Purpose

To report outcomes of intra-arterial thrombolysis versus non-thrombolytic management of severe frostbite with respect to digital amputation rates and hospital length of stay (LOS).

Materials and Methods

Seventeen patients with severe frostbite were identified from 2000 to 2017. Eight (47%) patients with mean age of 40 years underwent intra-arterial thrombolysis and served as the treatment group. Nine (53%) patients with mean age of 53 years received non-thrombolytic management and served as the control group. 2/8 (25%) treatment and 3/9 (33%) control patients had underlying vascular comorbidities (p = 0.25). Number of digits at risk, duration of thrombolysis, thrombolytic agents used, digits amputated, hospital LOS, and complications were recorded.

Results

Seven upper and nine lower extremities for a total of 80 digits were at risk in the treatment cohort. Eight upper and 12 lower extremities for a total of 100 digits were at risk in the control group. Mean duration of thrombolysis was 26 h. All treatment patients received tissue plasminogen activator in addition to systemic heparin. 4/16 (25%) limbs received intra-arterial alprostadil, 2/16 (13%) received nitroglycerin, and 2/16 (13%) received nicardipine. 12/80 (15%) treatment digits and 77/100 (77%) control digits required amputation (p = 0.003). Average hospital LOS was 14 days in the treatment group and 38 days in the control group (p = 0.011). No major complications occurred in the treatment group; however, 2/9 (22%) patients in the control group required extended hospitalizations secondary to amputation complications.

Conclusions

Intra-arterial thrombolysis reduces digital amputation rates and hospital LOS in the setting of severe frostbite.

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Abbreviations

tPA:

Tissue plasminogen activator

LOS:

Length of stay

ICD:

International Statistical Classification of Diseases and Related Health Problems

ICU:

Intensive care unit

CT:

Computed tomography

INR:

International normalized ratio

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Correspondence to Jeffrey Forris Beecham Chick.

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The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Patel, N., Srinivasa, D.R., Srinivasa, R.N. et al. Intra-arterial Thrombolysis for Extremity Frostbite Decreases Digital Amputation Rates and Hospital Length of Stay. Cardiovasc Intervent Radiol 40, 1824–1831 (2017). https://doi.org/10.1007/s00270-017-1729-7

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Keywords

  • Frostbite
  • Hypothermic injury
  • Cold injury
  • Thrombolysis
  • Endovascular therapy
  • Extremity frostbite
  • Digital amputation
  • Interventional radiology
  • Plastic surgery