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Precision in practice, save the limb, save the life: Early detection of grade IIA acute limb ischemia and management using catheter-directed thrombolysis - A case report

Heart Science Journal · Vol. 6 No. 2 (2025)

DOI
10.21776/ub.hsj.2025.006.02.20
ISSN
2721-9984, 2721-9976
Terbit
2025-04-30
Penerbit
Universitas Brawijaya
Bahasa
en
Lisensi
creativecommons.org/licenses/by/4.0

Abstrak

Background: Acute limb ischemia is an emergency condition that causes high morbidity and mortality. Endovascular revascularization in acute limb ischemia showed better in-hospital clinical outcomes than surgical revascularization. Case illustration: A 67-year-old man was referred by internal medicine at the rural area hospital with a diagnosis of acute limb ischemia. He complained of sudden left leg pain and numbness of the left leg 2 days prior to hospital admission. He was a heavy smoker and had a predisposition for atrial fibrillation. He received heparinization at the previous hospital. Upon arriving at Saiful Anwar Hospital, a physical examination showed severe left leg pain and was difficult to move. His left leg was pulseless, paresthesia and poikilothermia. Duplex ultrasound revealed a thrombus in the left popliteal artery with no flow downwards. We diagnosed the patient with Acute Limb Ischemia Rutherford IIA left inferior extremity. We decided to perform catheter-directed thrombolysis with the Alteplase regiment. Post catheter-directed thrombolysis angiography evaluation showed TIMI flow II at the left leg after 24-hour catheter-directed thrombolysis. The patient did not complain of leg pain or numbness anymore. Conclusion: Good outcomes in this patient were obtained through the ability to make correct initial diagnosis, early administration of heparin, and immediate referral to a cardiovascular center that can provide endovascular treatment. Catheter-directed thrombolysis is the right choice for grade IIA acute limb ischemia

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  • University of Brawijaya
  • RSUD Prof. Dr. Saiful Anwar Malang
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Rekan penulisOrganisasiArtikel bersama
Mohammad Saifur RohmanUniversity of Brawijaya14
Cholid Tri TjahjonoUniversity of Brawijaya12
Sasmojo WiditoUniversity of Brawijaya12
Djanggan SargowoUniversity of Brawijaya10
Ardian RizalUniversity of Brawijaya10
Anna Fuji RahimahUniversity of Brawijaya10
Indra PrasetyaUniversity of Brawijaya9
Budi SatrijoUniversity of Brawijaya8
Heny MartiniUniversity of Brawijaya7
Setyasih AnjarwaniUniversity of Brawijaya5
Muchammad Dzikrul Haq KarimullahUniversity of Brawijaya4
Hiradipta ArdiningAfiliasi tidak diketahui3
Seprian WidasmaraUniversity of Brawijaya3
Adhika Prastya WikanandaUniversity of Brawijaya3
Sawitri SatwikajatiUniversity of Brawijaya3
Putri Annisa KamilaUniversity of Brawijaya2
Irma KameliaUniversity of Brawijaya2
Dyah Ayu IkeningrumRSUD Prof. Dr. Saiful Anwar Malang2
Oktafin Srywati PamunaUniversity of Brawijaya2
Zainal FathurohimUniversity of Brawijaya2
Nikhen NoverikeUniversity of Brawijaya2
Titin Andri WihastutiUniversity of Brawijaya2
Ira Vori NugrohoUniversity of Brawijaya2
Imam Mi'raj SuprayogaUniversity of Brawijaya2
Malombassi Dharmawan Hadiwidjojo HutomoUniversity of Brawijaya2
Wella KarolinaUniversity of Brawijaya2
Ryan RamadhanUniversity of Brawijaya1
Ardian RizalUniversity of Brawijaya1
Veny KurniawatiUniversity of Brawijaya1
Aris Munandar Zulkifli IsmailUniversity of Brawijaya1
Dedy IrawanUniversity of Brawijaya1
Monika SitioUniversity of Brawijaya1
Muhammad Rizki FadlanUniversity of Brawijaya1
Liemena Harold AdrianRSUD Prof. Dr. Saiful Anwar Malang1
Ayu Asri Devi AdityawatiUniversity of Brawijaya1
Anna Fuji RahimahAfiliasi tidak diketahui1
Imelda KrisnasariUniversity of Brawijaya1

Afiliasi berasal dari OpenAlex; metadata OAI-PMH jurnal tidak memuatnya. Penulis tanpa ID OpenAlex dicocokkan berdasarkan nama, sehingga dua orang bisa tergabung atau satu orang bisa terpisah.

Sumber metadata: OAI-PMH (metadata jurnal) https://heartscience.ub.ac.id/index.php/heartscience/oai, pertama di-harvest 8 Nov 2026, terakhir terlihat 8 Nov 2026.
Metadata asli (oai_dc) 
<oai_dc:dc xmlns="http://www.openarchives.org/OAI/2.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/  http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
	<dc:title xml:lang="en">Precision in practice, save the limb, save the life: Early detection of grade IIA acute limb ischemia and management using catheter-directed thrombolysis - A case report</dc:title>
	<dc:creator xml:lang="en">Niazta, Nisa Amnifolia</dc:creator>
	<dc:creator xml:lang="en">Kurnianingsih, Novi</dc:creator>
	<dc:creator xml:lang="en">Kurniawan, Dea Arie</dc:creator>
	<dc:subject xml:lang="en">acute limb ischemia</dc:subject>
	<dc:subject xml:lang="en">peripheral artery disease</dc:subject>
	<dc:subject xml:lang="en">catheter-directed thrombolysis.</dc:subject>
	<dc:description xml:lang="en">Background: Acute limb ischemia is an emergency condition that causes high morbidity and mortality. Endovascular revascularization in acute limb ischemia showed better in-hospital clinical outcomes than surgical revascularization.
Case illustration: A 67-year-old man was referred by internal medicine at the rural area hospital with a diagnosis of acute limb ischemia. He complained of sudden left leg pain and numbness of the left leg 2 days prior to hospital admission. He was a heavy smoker and had a predisposition for atrial fibrillation. He received heparinization at the previous hospital. Upon arriving at Saiful Anwar Hospital, a physical examination showed severe left leg pain and was difficult to move. His left leg was pulseless, paresthesia and poikilothermia. Duplex ultrasound revealed a thrombus in the left popliteal artery with no flow downwards. We diagnosed the patient with Acute Limb Ischemia Rutherford IIA left inferior extremity. We decided to perform catheter-directed thrombolysis with the Alteplase regiment. Post catheter-directed thrombolysis angiography evaluation showed TIMI flow II at the left leg after 24-hour catheter-directed thrombolysis. The patient did not complain of leg pain or numbness anymore.
Conclusion: Good outcomes in this patient were obtained through the ability to make correct initial diagnosis, early administration of heparin, and immediate referral to a cardiovascular center that can provide endovascular treatment. Catheter-directed thrombolysis is the right choice for grade IIA acute limb ischemia</dc:description>
	<dc:publisher xml:lang="en">Universitas Brawijaya</dc:publisher>
	<dc:date>2025-04-30</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>https://heartscience.ub.ac.id/index.php/heartscience/article/view/20240</dc:identifier>
	<dc:identifier>10.21776/ub.hsj.2025.006.02.20</dc:identifier>
	<dc:source xml:lang="en">Heart Science Journal; Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder</dc:source>
	<dc:source>2721-9984</dc:source>
	<dc:source>2721-9976</dc:source>
	<dc:source>10.21776/ub.hsj.2025.006.02</dc:source>
	<dc:language>en</dc:language>
	<dc:relation>https://heartscience.ub.ac.id/index.php/heartscience/article/view/20240/503</dc:relation>
	<dc:rights xml:lang="en">Copyright (c) 2025 Nisa Amnifolia Niazta, Novi Kurnianingsih, Dea Arie Kurniawan</dc:rights>
	<dc:rights xml:lang="en">http://creativecommons.org/licenses/by/4.0</dc:rights>
</oai_dc:dc>