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

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.