Midterm results of catheter-directed thrombolysis in patients with vasculitis with acute ischemia

Background Acute limb ischemia (ALI) of the lower extremities remains and will always be a challenging dilemma with a high risk for major amputation. Treatment of ALI has shifted toward endovascular therapies. This study aimed to assess the outcomes of lytic therapy in patients with vasculitis patients with acute ischemia. Patients and methods This prospective study included patients with vasculitis with ALI of the upper and lower extremities treated via endovascular intra-arterial thrombolysis between January 2016 and December 2019. A total of 69 patients underwent intra-arterial thrombolysis via alteplase. A 24- and 48-h follow-up angiogram was done to monitor the results. Complications, need for secondary intervention, and limb survival without amputation were assessed for 2-3 years of follow-up. Results Complete clot lysis was seen in 60 of 69 patients, with complete resolution of pain and cyanosis. Access-site hematoma and one pseudoaneurysm were treated with manual compression under echo guidance. Three cases experienced ischemic pain for two weeks after intervention. Six patients in the study did major amputation owing to sudden discontinuation of lytic therapy before complete thrombolysis. Conclusions Endovascular thrombolysis remains an effective treatment option for patients with vasculitis presenting with ALI.