O-133 - CATHETER DIRECTED THROMBOLYSIS FOR NOT IMMEDIATELY THREATENED ACUTE LIMB ISCHAEMIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Doelare S. (Amsterdam University Medical Centers ~ Amsterdam ~ Netherlands) , Koedam T. (Amsterdam University Medical Centers ~ Amsterdam ~ Netherlands) , Ebben H. (Amsterdam University Medical Centers ~ Amsterdam ~ Netherlands) , Tournoij E. (Dijklander Hospital ~ Hoorn ~ Netherlands) , Hoksbergen A. (Amsterdam University Medical Centers ~ Amsterdam ~ Netherlands) , Yeung K.K. (Amsterdam University Medical Centers ~ Amsterdam ~ Netherlands) , Jongkind V. (Amsterdam University Medical Centers ~ Amsterdam ~ Netherlands)
Introduction:
Catheter-directed thrombolysis (CDT) is an established treatment in case of threatening acute limb ischaemia (ALI). Furthermore, CDT can also be used to treat patients with not immediately threatened ALI, aiming to improve functional outcome and/or prevent more extensive revascularization in the near future. Currently, specific outcomes of CDT for not immediately threatened ALI are unknown. This systematic review and meta-analysis reports the outcomes of CDT for patients presenting with not immediately threatened ALI.
Methods:
PubMed, Embase and Cochrane were systematically searched for relevant studies describing the outcomes of CDT in patients with not immediately threatened ALI. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Additional data was retrieved from the authors and a meta-analysis was performed using a random effects model.
Results:
Thirty-nine studies were included, comprising 1861 patients who received CDT for not immediately threatened ALI. Funnel plots showed indication for publication bias and heterogeneity was substantial. Pooled treatment duration was 2 days (95% confidence interval (CI) 1-2%), with angiographic success of 80% (95% CI 73-86%) and 30-day freedom of amputation in 98% of patients (95% CI 92-100%). Major bleeding rate was 5% (95% CI 2-14%) with a 30-day mortality rate of 3% (95% CI 1-5%). Amputation-free survival rate was 71% (95% CI 62-80%) at 1-year and 63% (95% CI 51-73%) at 3-years follow-up. Long-term patency rates could be retrieved from 4 studies: 48% at 1 year (95% CI: 27-70%). No data could be retrieved on walking distance of the patients.
Conclusion:
This meta-analysis demonstrated that CDT can be performed in Rutherford-I patients with high angiographic success (80%). However, after one year, all-cause mortality, vascular patency and amputation rates paint a sobering picture for these patients. Further research is required to assess the outcome of CDT versus conservative treatment on functional status and amputation free survival. Efforts should be made to improve long-term outcome for patients suffering from ALI.