Tags

Type your tag names separated by a space and hit enter

What Interventional Radiologists Need to Know About Managing Severe Frostbite: A Meta-Analysis of Thrombolytic Therapy.
AJR Am J Roentgenol. 2020 04; 214(4):930-937.AA

Abstract

OBJECTIVE.

The purpose of this study is to review the various techniques and clinical management paradigms using tissue plasminogen activator (tPA) to treat severe frostbite injuries, which are relevant to the interventional radiologist. MATERIALS AND

METHODS.

A literature search yielded 157 citations, which were manually screened for inclusion criteria of case reports, case series, cohort studies, and randomized prospective studies that reported the use of tPA to treat severe frostbite injuries, of which 16 qualified for review. Data extracted from the studies included authors, journal, year of publication, initial assessment and management of severe frostbite injuries, inclusion and exclusion criteria for tPA therapy, treatment and control group size, different imaging modalities used in evaluation of severe frostbite injuries, tPA treatment protocols, outcomes, and side effects or complications.

RESULTS.

The analyzed series included 209 patients with 1109 digits at risk of amputation who were treated with intraarterial (IA) or IV tPA (116 and 77 patients, respectively). A total of 926 digits at risk were treated with IA tPA and resulted in amputation of 222 digits, for a salvage rate of 76%. Twenty-four of 63 patients underwent amputation after IV tPA, resulting in a salvage rate of 62%. Both digital subtraction angiography and triple-phase bone scan were used for initial imaging evaluation. Additional concurrent treatment included therapeutic heparin, warfarin, nonsteroidal antiinflammatory drugs, pain management, and light dressings with topical antimicrobial agents.

CONCLUSION.

Severe frostbite injuries can lead to devastating outcomes with loss of limbs and digits, yet clinical management continues to consist primarily of tissue rewarming, prolonged watchful waiting, and often delayed amputation. Recent studies have shown promising results using both IA and IV tPA to reduce amputation after severe frostbite injuries. Through a meta-analysis of thrombolytic therapy in the management of severe frostbite, this article provides a useful guideline for interventional radiologists including a suggested protocol, inclusion and exclusion criteria, and potential complications.

Authors+Show Affiliations

Department of Radiology, Boston Medical Center, 820 Harrison Ave, FGH Bldg, 3rd Fl, Boston, MA 02118.Department of Radiology, Boston Medical Center, 820 Harrison Ave, FGH Bldg, 3rd Fl, Boston, MA 02118.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

32023122

Citation

Lee, John, and Mikhail C S S. Higgins. "What Interventional Radiologists Need to Know About Managing Severe Frostbite: a Meta-Analysis of Thrombolytic Therapy." AJR. American Journal of Roentgenology, vol. 214, no. 4, 2020, pp. 930-937.
Lee J, Higgins MCSS. What Interventional Radiologists Need to Know About Managing Severe Frostbite: A Meta-Analysis of Thrombolytic Therapy. AJR Am J Roentgenol. 2020;214(4):930-937.
Lee, J., & Higgins, M. C. S. S. (2020). What Interventional Radiologists Need to Know About Managing Severe Frostbite: A Meta-Analysis of Thrombolytic Therapy. AJR. American Journal of Roentgenology, 214(4), 930-937. https://doi.org/10.2214/AJR.19.21592
Lee J, Higgins MCSS. What Interventional Radiologists Need to Know About Managing Severe Frostbite: a Meta-Analysis of Thrombolytic Therapy. AJR Am J Roentgenol. 2020;214(4):930-937. PubMed PMID: 32023122.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What Interventional Radiologists Need to Know About Managing Severe Frostbite: A Meta-Analysis of Thrombolytic Therapy. AU - Lee,John, AU - Higgins,Mikhail C S S, Y1 - 2020/02/05/ PY - 2020/2/6/pubmed PY - 2020/5/13/medline PY - 2020/2/6/entrez KW - frostbite KW - thrombolytic KW - tissue plasminogen activator SP - 930 EP - 937 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 214 IS - 4 N2 - OBJECTIVE. The purpose of this study is to review the various techniques and clinical management paradigms using tissue plasminogen activator (tPA) to treat severe frostbite injuries, which are relevant to the interventional radiologist. MATERIALS AND METHODS. A literature search yielded 157 citations, which were manually screened for inclusion criteria of case reports, case series, cohort studies, and randomized prospective studies that reported the use of tPA to treat severe frostbite injuries, of which 16 qualified for review. Data extracted from the studies included authors, journal, year of publication, initial assessment and management of severe frostbite injuries, inclusion and exclusion criteria for tPA therapy, treatment and control group size, different imaging modalities used in evaluation of severe frostbite injuries, tPA treatment protocols, outcomes, and side effects or complications. RESULTS. The analyzed series included 209 patients with 1109 digits at risk of amputation who were treated with intraarterial (IA) or IV tPA (116 and 77 patients, respectively). A total of 926 digits at risk were treated with IA tPA and resulted in amputation of 222 digits, for a salvage rate of 76%. Twenty-four of 63 patients underwent amputation after IV tPA, resulting in a salvage rate of 62%. Both digital subtraction angiography and triple-phase bone scan were used for initial imaging evaluation. Additional concurrent treatment included therapeutic heparin, warfarin, nonsteroidal antiinflammatory drugs, pain management, and light dressings with topical antimicrobial agents. CONCLUSION. Severe frostbite injuries can lead to devastating outcomes with loss of limbs and digits, yet clinical management continues to consist primarily of tissue rewarming, prolonged watchful waiting, and often delayed amputation. Recent studies have shown promising results using both IA and IV tPA to reduce amputation after severe frostbite injuries. Through a meta-analysis of thrombolytic therapy in the management of severe frostbite, this article provides a useful guideline for interventional radiologists including a suggested protocol, inclusion and exclusion criteria, and potential complications. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/32023122/What_Interventional_Radiologists_Need_to_Know_About_Managing_Severe_Frostbite:_A_Meta_Analysis_of_Thrombolytic_Therapy_ L2 - http://www.ajronline.org/doi/full/10.2214/AJR.19.21592 DB - PRIME DP - Unbound Medicine ER -