Peripheral Intra Arterial Thrombolysis
Peripheral Intra Arterial Thrombolysis (PIAT): Cannulate the vessel and pass a guidewire across the thrombus before thrombolysis. Heparin is given intravenously as soon as the guide wire passes the thrombus. Heparin bolus of 70 units per / kg followed by infusion of 1000 units / hour (maintain APTT 1.5 to 2.5 times control). Catheter with multiple side holes id used for thrombolysis.
Streptokinase is not generally used in view of bleeding complications. Either Urokinase or tPA (tissue type plasminogen activator) is used. Immediate success is achieved in 60-90% and 2 year patency upto 80%.
Complications expected with PIAT
Most common complication: 3 -20% site bleed.
Intracranial bleeds can occur in 0.5 – 2%.
8% may develop myocardial infarction.
Balloon catheter guided PIAT
A new method for PIAT is using a porous balloon with low pressure . Recanalization could be obtained in 13 of the 14 cases in this study and the usage of fibrinolytic agent was low. The limb salvage rate 6 months after recanalization was 92% and the mean stay in the monitored are was around one day. This method could reduce hemorrhagic risk in the elderly because of localized delivery of lower quantity of fibrinolytic agent.
- Dakhil B, Lacal P, Abdesselam AB, Couffinhal JC, Gordienco A, Bagan P. Evaluation of balloon catheter-guided intra-arterial thrombolysis for acute peripheral arterial occlusion. Ann Vasc Surg. 2013 Aug;27(6):781-4.