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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 12/2017

01-12-2017 | Clinical Investigation

Intra-arterial Thrombolysis for Extremity Frostbite Decreases Digital Amputation Rates and Hospital Length of Stay

Authors: Nishant Patel, Dhivya R. Srinivasa, Ravi N. Srinivasa, Joseph J. Gemmete, Venkat Krishnamurthy, Narasimham Dasika, Shilpa N. Reddy, Matthew L. Osher, Erika D. Sears, Jeffrey Forris Beecham Chick

Published in: CardioVascular and Interventional Radiology | Issue 12/2017

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Abstract

Purpose

To report outcomes of intra-arterial thrombolysis versus non-thrombolytic management of severe frostbite with respect to digital amputation rates and hospital length of stay (LOS).

Materials and Methods

Seventeen patients with severe frostbite were identified from 2000 to 2017. Eight (47%) patients with mean age of 40 years underwent intra-arterial thrombolysis and served as the treatment group. Nine (53%) patients with mean age of 53 years received non-thrombolytic management and served as the control group. 2/8 (25%) treatment and 3/9 (33%) control patients had underlying vascular comorbidities (p = 0.25). Number of digits at risk, duration of thrombolysis, thrombolytic agents used, digits amputated, hospital LOS, and complications were recorded.

Results

Seven upper and nine lower extremities for a total of 80 digits were at risk in the treatment cohort. Eight upper and 12 lower extremities for a total of 100 digits were at risk in the control group. Mean duration of thrombolysis was 26 h. All treatment patients received tissue plasminogen activator in addition to systemic heparin. 4/16 (25%) limbs received intra-arterial alprostadil, 2/16 (13%) received nitroglycerin, and 2/16 (13%) received nicardipine. 12/80 (15%) treatment digits and 77/100 (77%) control digits required amputation (p = 0.003). Average hospital LOS was 14 days in the treatment group and 38 days in the control group (p = 0.011). No major complications occurred in the treatment group; however, 2/9 (22%) patients in the control group required extended hospitalizations secondary to amputation complications.

Conclusions

Intra-arterial thrombolysis reduces digital amputation rates and hospital LOS in the setting of severe frostbite.
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Metadata
Title
Intra-arterial Thrombolysis for Extremity Frostbite Decreases Digital Amputation Rates and Hospital Length of Stay
Authors
Nishant Patel
Dhivya R. Srinivasa
Ravi N. Srinivasa
Joseph J. Gemmete
Venkat Krishnamurthy
Narasimham Dasika
Shilpa N. Reddy
Matthew L. Osher
Erika D. Sears
Jeffrey Forris Beecham Chick
Publication date
01-12-2017
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 12/2017
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-017-1729-7

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