Analiza uspješnosti liječenja akutne ishemije gornjeg i donjeg ekstremiteta selektivnom fibrinolitičkom terapijom u Kliničkom bolničkom centru Zagreb

master's thesis

• Title (english): Outcomes of catheter-directed thrombolysis for acute upper and lower limb ischemia at the University Hospital Center Zagreb
• Author: Nikolina Jupek
• Mentor: Majda Vrkić Kirhmajer (mentor)
• Committee member: Kristina Marić Bešić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Majda Vrkić Kirhmajer (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Akutna ishemija ekstremiteta je stanje kod kojeg dolazi do naglog pada u perfuziji ekstremiteta i zahtjeva hitno zbrinjavanje. Terapijske opcije za liječenje akutne ishemije ekstremiteta su kirurška revaskularizacija, endovaskularne i hibridne metode. Odabir terapijske opcije ovisi o tipu okluzije (tromb ili embolus), lokalizaciji i morfologiji okludirane žile, vijabilnosti ekstremiteta, trajanju ishemije i komorbiditetima. Provedeno je retrospektivno istraživanje na 48 bolesnika kod kojih je postavljena dijagnoza akutne ishemije ekstremiteta, sa simptomima ishemije ne starijim od 14 dana i vijabilnim ekstremitetom, liječenih selektivnom fibrinolitičkom terapijom u razdoblju od 1. siječnja 2012. do 10. veljače 2022. u Kliničkom bolničkom centru Zagreb. Medijan trajanja simptoma je iznosio 3 dana, aplicirana doze alteplaze 33,0 mg s medijanom trajanja primjene 22 sata. Klinički uspjeh je postignut u 81,3% bolesnika, a tehnički u 77,3%. Tijekom zahvata 5 bolesnika je imalo ukupno 6 velikih komplikacija. Utvrđena je statistički značajna povezanost između kliničkog uspjeha i zahvata na nativnim arterijama, a nepovoljni klinički ishodi su vezani uz duljinu okluzije >20 cm, velike komplikacije i predintervencijsku upotrebu statina. Postignuti klinički uspjeh je dugoročno vezan uz veći pedobrahijalni indeks. Zaključno, selektivna intraarterijska fibrinolitička terapija je uspješna revaskularizacijska metoda s malim brojem komplikacija u akutnoj ishemiji ekstremiteta kod pacijenata Rutherford kategorije I i IIa.

Abstract (english)

Acute limb ischemia is defined as the sudden decrease in limb perfusion that requires urgent treatment. Treatment methods for acute limb ischemia include surgical treatment, endovascular treatment, and hybrid treatment. The therapeutic strategy will depend on the type of occlusion (thrombus or embolus), localization and morphology of the occluded vessel, duration of ischemia, and comorbidities. The retrospective study was conducted on 48 patients who were diagnosed with acute limb ischemia, with symptoms of ischemia not older than 14 days and viable extremity, treated with selective fibrinolytic therapy at the University Hospital Center Zagreb between January 1, 2012 and February 10, 2022. The median duration of symptoms was 3 days, a dose of 33.0 mg of alteplase was administrated, and the median duration of application was 22 hours. Clinical success was achieved in 81.3% of patients and technical in 77.3%. During the procedure 5 patients had a total of 6 major complications. A statistically significant association was found between clinical success and intervention on native blood vessels, and adverse clinical outcomes were associated with occlusion length> 20 cm, major complications and pre-interventional statin use. Clinical success has a long-term connection with a higher ankle-brachial index. In conclusion, catheter-directed thrombolysis is a successful revascularization method with a small number of complications in acute limb ischemia in Rutherford categories I and IIa.

• Keywords: akutna ishemija ekstremiteta; pedobrahijalni indeks; selektivna fibrinolitička terapija
• Keywords (english): acute limb ischemia; ankle-brachial index; catheter-directed thrombolysis
• Language: croatian
• URN:NBN: urn:nbn:hr:105:799848
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-13 08:18:42