When is thrombolysis for acute lower limb ischemia worthwhile?

Objectives: To find variables associated with outcome following thrombolytic treatment for acute lower limb ischemia.
Design: Re-analysis of a prospective multicentre study.
Material and Methods: One hundred and twenty-one patients with acute lower limb ischemia previously included in a randomised study comparing high- with low-dose thrombolysis were re-analysed ignoring the mode of lytic treatment. All possibly predictive variables were subjected to multivariate analyses to find associations with outcome.
Results: Previous successful thrombolysis, ankle-brachial index over 0.33, absence of motor dysfunction, presence of cardiac arrhythmia, and lysis of a vascular graft were all associated with successful thrombolysis (p=0.003). Previous thrombolysis, age less than 70 years, and ankle-brachial index over 0.33 were all perfect predictors of absence of life-threatening complications or death. Successful lysis, age<70, and lysis of a native artery as opposed to a vascular graft were all associated with clinical success (preserved patency, limb, and life) after one year (p=0.002).
Conclusions: Previous thrombolysis, age under 70 years, and non-severe ischemia predict successful thrombolysis free from severe complications. Successful thrombolysis is strongly predictive of amputation-free survival with vascular patency for at least one year. Occluded grafts could often be reopened, but long-term outcome is better after thrombolysis of native arteries.