Outcomes of intra-operative thrombolysis in late acute arterial embolism of the lower limb in a cohort of patients in thailand

Background: Patients with acute arterial embolism of the lower limb who present early and are treated promptly. Surgical embolectomy is successful more than 90%. Patients with late presentation of acute arterial embolism of the lower limb with immediate threatened severity (Rutherford grade IIB), need emergency revascularization. Surgical embolectomy without adjunctive treatment is successful in only 60 to 70%. The patients need to get intraoperative thrombolysis to improve the outcome of treatment. Objective: We sought to establish the outcomes of Thai patients undergoing intra-operative thrombolysis combined with surgical embolectomy for late acute arterial embolism of the lower limb who presented with immediately threatened severity (Rutherford grade IIB). We aimed to use our findings to inform the development of new treatment guidelines and protocols in Thailand. Material and Method: We reviewed the records of 37 late-presenting patients with immediately threatened severity lower limb ischemia who underwent embolectomy with intra-operative thrombolysis between January 1995 and December 2014 under the care of the Department of Vascular Surgery, Siriraj Hospital, Bangkok, Thailand. We recorded patients’ demographic data, intra-operative data, postoperative complications, limb salvageability rate and mortality rate 1 month and 1 year after treatment. Results: The median time that elapsed between symptom onset and revascularization was 7 day (range 1 to 120 day). Twenty-two patients (59.5%) were treated with streptokinase, with the remainder treated with recombinant tissue plasminogen activator. The limb salvageability rate within 1 month and 1 year showed the same results (89.2%). The mortality rate within 1 month was 5.4% but 10.8% at 1 year. The recovery of four patients was complicated by hemorrhage, seven by rethrombosis, three by wound hematoma, one by postoperative myocardial infarction, one by surgical site infection and one by gangrene. Conclusion: Intra-operative thrombolysis is a safe and effective adjunct to embolectomy that increases limb salvageability in Thai patients with late acute arterial embolism of the lower limb.