Treatment of Aortoiliac Embolism When Initial Revascularisation Has Not Achieved Angiographic Improvement
This protocol addresses the clinical situation where a first-line revascularisation attempt for aortoiliac embolism has been performed but has not produced the required improvement of the treated limb on angiography within the expected window.
Previous Treatment — Failure Condition
The patient has already undergone one of the following first-line interventions:
- Surgical thrombo-embolectomy (under regional or local anaesthesia with an anaesthetist present, using over-the-wire embolectomy catheters under fluoroscopic control) with completion angiography
- Catheter-directed thrombolysis using recombinant tissue plasminogen activator (alteplase) or urokinase
- Percutaneous aspiration and mechanical thrombectomy
Escalation trigger: failure to achieve improvement of the treated limb on angiography within 6–12 hours.
When the angiographic target has not been reached after open surgery, the structured next step involves endovascular options directed at residual inflow or outflow issues — the full sequenced regimen is available via the link below.
References
DOI: 10.1016/j.ejvs.2019.09.006
- After open revascularisation for acute limb ischaemia, simultaneous endovascular treatment addressing inflow or outflow stenosis should be considered.
- For patients with residual thrombus after open surgery for acute limb ischaemia, intra-operative local thrombolysis may be considered.
- A widely used alternative is intra-operative instillation of thrombolytic agents (e.g., recombinant tissue plasminogen activator [rtPA] 4–10 mg) directly into the artery downstream with the aim of dissolving residual thrombus.