Comparative Analysis of the Treatment of Patients with Lower Limb Artery Thrombosis and Outflow Artery Injury Using Recombinant Tissue Plasminogen Activator as a Thrombolytic Agent
Abstract
Aim. To evaluate the effectiveness of recombinant tissue plasminogen activator (rtPA) in the treatment of patients with lower limb arterial thrombosis and outflow artery injury, and to conduct a comparative analysis of treatment following catheter-directed thrombolysis (CDT).
Materials and Methods. The study analyzed the treatment outcomes of 64 patients who underwent CDT using rtPA. During the postoperative period and at the outpatient stage of treatment, patients received anticoagulant therapy according to the VOYAGER PAD protocol and underwent regular duplex ultrasound (DUS) vascular monitoring.
Results. Most patients demonstrated marked regression of ischemia, reduction of pain syndrome, and absence of critical hemorrhagic complications. Limb preservation was achieved in 93.3 % of patients within 2 months after CDT. The use of CDT allowed achieving a high rate of revascularization and reduced the risk of recurrent thrombosis.
Conclusions. Recombinant tissue plasminogen activator (rtPA) is an effective thrombolytic agent for CDT in the treatment of patients with acute lower limb arterial thrombosis (ALLAT) and concomitant outflow artery injury. The results of this study suggest that endovascular methods with additional angiographic control of distal blood flow are a recommended treatment option for patients with ALLAT and run-off arterial lesions. These methods demonstrated a high success rate in revascularizing the affected arteries and improving the degree of lower-limb ischemia, as evidenced by regression according to the Rutherford classification. The combination of CDT with secondary angioplasty proved beneficial in certain patients with hemodynamically significant steno-occlusions that may have contributed to run-off arterial thrombosis.
References
- Luan TMB, Bang HT, Tan NM, et al. Catheter-directed intra-arterial thrombolysis in the treatment of acute thrombosis of below-the-knee arteries. Radiol Case Rep. 2021;16(8):2086–90. Available from: https://doi.org/10.1016/j.radcr.2021.05.012
- Ahmed A, Naeem N, Jain A, Arora S, Elgendy IY. Acute Limb Ischemia Interventions. Interv Cardiol Clin. 2025;14(2):273–82. Available from: https://doi.org/10.1016/j.iccl.2024.11.012
- Theodoridis PG, Davos CH, Dodos I, et al. Thrombolysis in acute lower limb ischemia: Review of the current literature. Ann Vasc Surg. 2018;52:255–62. Available from: https://doi.org/10.1016/j.avsg.2018.02.030
- Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5–67. Available from: https://doi.org/10.1016/j.jvs.2006.12.037
- Hiatt WR, Bonaca MP, Patel MR, et al. Rivaroxaban and aspirin in peripheral artery disease lower extremity revascularization: Impact of concomitant clopidogrel on efficacy and safety. Circulation. 2020;142(23):2219–30. Available from: https://doi.org/10.1161/CIRCULATIONAHA.120.050465
- Dragas M, Zlatanovic P, Koncar I, et al. Effect of intra-operative intra-arterial thrombolysis on long term clinical outcomes in patients with acute popliteal artery aneurysm thrombosis. Eur J Vasc Endovasc Surg. 2020;59(2):255–64. Available from: https://doi.org/10.1016/j.ejvs.2019.10.013
- Hupalo YM, Makivchuk DA. Catheter directed thrombolysis in acute limb ischemia patients: A single center’s experience. Wiad Lek. 2023;76(10):2156–60. Available from: https://doi.org/10.36740/WLek202310104
- Cheng SC, Wang Z, Cao XS, Zhang YZ, Wang XC, Han XQ. Clinical efficacy of simultaneous versus staged stent implantation after percutaneous mechanical thrombectomy in IVCS patients with acute IFDVT. Saudi Med J. 2025;46(7):836–40. Available from: https://doi.org/10.15537/smj.2025.46.7.20240859
- Makivchuk DA, Hupalo YM, Didenko SM. Analysis of the outcomes of catheter-directed thrombolysis in patients with lower limb arterial thrombosis involving outflow arteries. Clin Prev Med. 2025;(3):76–83. Available from: https://doi.org/10.31612/2616-4868.3.2025.10
- Zatykó DZ, Pomozi E, Pataki Á, Szeberin Z. Akut, kritikus alsó végtagi ischaemia kezelése katéteres thrombolysissel [Catheter-directed thrombolysis in acute critical limb ischemia]. Orv Hetil. 2022;163(11):424–30. Available from: https://doi.org/10.1556/650.2022.32376
- Poorthuis MHF, Brand EC, Hazenberg CEVB, et al. Plasma fibrinogen level as a potential predictor of hemorrhagic complications after catheter-directed thrombolysis for peripheral arterial occlusions. J Vasc Surg. 2017;65(5):1519–26. Available from: https://doi.org/10.1016/j.jvs.2016.11.025
- Johnson LD, Cole JC, Erdman MJ, Boppana LKT, Najjar N, Shald EA, et al. Safety and efficacy of thrombolytic interventions in the treatment of intermediate and high-risk pulmonary embolism. Blood Coagul Fibrinolysis. 2025;36(6):253–60. Available from: https://doi.org/10.1097/MBC.0000000000001375
- Lakhter V, Bichard C, Ouriel K, Firth B, Rali P, Bashir R. Safety and Feasibility of On-the-Table Pharmacomechanical Lysis for Acute Intermediate-Risk Pulmonary Embolism: The RESCUE-II Study. JACC Adv. 2025;4(6 Pt 1):101789. Available from: https://doi.org/10.1016/j.jacadv.2025.101789
- Tao M, Zhang XH, Yan LW, Mo DC, He RX, Wang T, et al. Risk of intracerebral haemorrhage with tenecteplase versus alteplase in acute ischaemic stroke: a meta-analysis. J Neurol. 2025;272(5):334. Available from: https://doi.org/10.1007/s00415-025-13081-5
- Xie G, Jiang G, Huang L, Sun S, Li X, Wu B, et al. Asparagine Endopeptidase Inhibition Attenuates Tissue Plasminogen Activator-Induced Brain Hemorrhagic Transformation After Ischemic Stroke. CNS Neurosci Ther. 2025;31(3):e70345. Available from: https://doi.org/10.1111/cns.70345
