Catheter directed thrombolysis for Not Immediately Threatened Acute Limb Ischaemia: a Systematic Review and Meta-Analysis

Open AccessPublished:January 03, 2023DOI:
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      This systematic review and meta-analysis reports the outcomes of Catheter-directed thrombolysis (CDT) for patients with not immediately threatened (Rutherford-I) acute lower limb ischaemia (ALI).


      A systematic search of PubMed, Embase and Cochrane was performed to identify observational studies and trials published between 1990 and 2022 reporting on the results of CDT in patients with Rutherford-I ALI. A meta-analysis was performed using a random effects model with 95% confidence intervals (CI). The outcomes of interests were treatment duration, angiographic success, bleeding complications, amputation- and mortality rates, primary- and secondary patency and functional outcome expressed as pain-free walking distance.


      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. Data from 5-13 studies were included in the meta-analysis. Pooled treatment duration was 2 days (95% 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.


      Although CDT in the treatment of not immediately threatened ALI showed high angiographic success, the long-term outcomes are relatively poor with low patency and substantial risk of major amputation. Further research is required to interpret the outcome of CDT in the context of potential confounders such as age and comorbidities.



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