Catheter-Directed Thrombolysis To Treat Juxtarenal Aortic Occlusion

To present our initial experience with Catheter-directed thrombolysis (CDT) using urokinase for the treatment of juxtarenal aortic occlusion. This was a retrospective study of 14 patients with juxtarenal aortic occlusion treated with CDT for 2-6 days between March 2012 and March 2015 at the Department of Vascular Surgery of People's Hospital of Peking University. All patients had an occlusion of the abdominal aorta adjacent to the origin of the renal arteries and were diagnosed by computed tomography. All patients were classified as TransAtlantic Inter-Society Consensus II (TASC D). Successful thrombolysis was defined as a reduction of >50% of the thrombus volume. There were nine men (64%) and five women (36%). Mean age was 58.3 +/- 9.4 years. The main symptom was claudication in eight patients (57%), rest pain in four (29%), and ulceration in two (14%). The duration of disease was 30.8 +/- 24.7 months (range, 1-72 months). CDT lasted 6 days in 12 patients, 2 and 3 days in the other 2 patients. The use of CDT was successful in all 14 patients. Three patients complained of transient pain, but it did not need intervention. No patient experienced perioperative visceral embolization. Limb ischemia was significantly relieved in all patients. At 1 year of follow-up, two patients presented asymptomatic re-occlusion. CDT could be considered in the treatment of juxtarenal aortic occlusion.