Archives of the Turkish Society of Cardiology
Subacute lower extremity arterial thrombosis; early outcomes of catheter directed thrombolysis with alteplase and importance of malnutrition assessed by CONUT score [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2021; 49(7): 568-578 | DOI: 10.5543/tkda.2021.21140

Subacute lower extremity arterial thrombosis; early outcomes of catheter directed thrombolysis with alteplase and importance of malnutrition assessed by CONUT score

Münevver Sarı, Ender Özgün Çakmak, Ali Karagöz, Fatih Yılmaz, Mehmet Aytürk, Serdar Fidan, Elnur Alizade, Uğur Arslantaş, Hacer Ceren Tokgöz, Zeynep Esra Güner, Gökhan Alıcı, Birol Özkan, Selçuk Pala
Department of Cardiology, University of Health Sciences Kartal Koşuyolu High Specialization Health Application and Research Center, İstanbul, Turkey


OBJECTIVE
In this study, we aimed to report early outcomes of catheter-directed thrombolysis (CDT) with alteplase in patients with subacute limb ischemia and to assess whether there is a link between malnutrition (determined by Controlling Nutritional Status [CONUT] score) and response to thrombolysis and bleeding.

METHODS
This was a retrospective study conducted between 2007 and 2020 with 118 patients with Rutherford class 3 (34.7%), class 4 (40.7%), and class 5 (24.6%) symptoms owing to infraaortic subacute thrombotic occlusion who were treated with catheter-directed thrombolysis.

RESULTS
Immediate technical success (Thrombolysis in Myocardial Infarction [TIMI] grade 2/3) was achieved in 56%, overall technical success after all adjunctive procedures was seen in 83.9%. Clinical success was obtained in 74.5% within 30 days. Major bleeding occurred in 11.8%. When we excluded access site hematomas, the rate of major bleeding was 5.1%. In-hospital mortality rate was 5.1%, and the amputation rate within 30 days was 12.7%. Any-degree malnutrition was detected in 48.3% according to CONUT score (≥2). Any-degree malnutrition was associated with failed thrombolysis and bleeding. The CONUT score predicted insufficient lytic response even after adjustment for confounding factors; however, serum C-reactive protein or neutrophil/lenfosit ratio did not. Other predictors of immediate technical failure after thrombolysis were symptom duration, Rutherford class 4/5 symptoms, and worsened distal runoff.

CONCLUSION
In patients with subacute limb ischemia, CDT combined with adjunctive interventions was effective in many patients at the expense of a substantial risk of bleeding and death. Malnutrition was associated with insufficient lytic response and bleeding. Physicians should be aware of malnutrition and consider the nutritional status of patients with limb ischemia when selecting appropriate treatment.


How to cite this article
Münevver Sarı, Ender Özgün Çakmak, Ali Karagöz, Fatih Yılmaz, Mehmet Aytürk, Serdar Fidan, Elnur Alizade, Uğur Arslantaş, Hacer Ceren Tokgöz, Zeynep Esra Güner, Gökhan Alıcı, Birol Özkan, Selçuk Pala. Subacute lower extremity arterial thrombosis; early outcomes of catheter directed thrombolysis with alteplase and importance of malnutrition assessed by CONUT score. Turk Kardiyol Dern Ars. 2021; 49(7): 568-578

Corresponding Author: Münevver Sarı, Türkiye
© Copyright 2021 Archives of the Turkish Society of Cardiology
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