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Abstract
BackgroundAcute limb ischemia is associated with significant mortality and amputation rate. Early restoration of flow can be obtained by various treatment methods that include catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT). These treatments have been shown to be effective but associated with various complications. There is lack of data comparing these two treatments. We aim to review our experience in the treatment of acute limb ischemia (ALI) and compare CDT with PMT.ResultsA total of 94 patients [mean age 65 years, 67% male (n = 63)] presented with ALI between 2006 and 2015 and were treated with either CDT or PMT. Outcomes were retrospectively reviewed. Primary outcomes were technical and clinical success; secondary outcomes were amputation rate at 30 days, duration of hospitalization and 30-day mortality. A total of 117 procedures were performed in 94 patients: 27 surgical bypass grafts, 31 previously stented arteries and 59 native vessels. Twenty eight procedures (24%) were performed with PMT, and 89 (76%) procedures were performed with CDT. Higher technical success was achieved in the PMT group (68%, 19/28) compared to the CDT group (47%, 42/89), p = 0.056. Clinical success was similar in both groups (75%, 21/28 in the PMT group and 73%, 65/89) in the CDT group (p = 0.837). There was no statistically significant difference in 30-day mortality between the PMT vs CDT groups (4% vs 8%, p = 0.425). The length of post-procedural hospital stay was shorter in patients with PMT (6.0 vs 12.6 days, p = 0.001). The absence of end-stage renal failure appears to be a predictor for clinical succes (HR 3.3, 95% CI 0.809–13.592).ConclusionPMT is associated with higher technical success and significantly shorter length of stay compared to CDT; however, clinical success is similar across both treatment entities. The safety profile is comparable.
Highlights
Acute limb ischemia (ALI) is defined as a sudden significant decrease in limb perfusion that has been present for less than 14 days that is causing a threat to limb viability (Patel et al, 2003)
The duration of symptoms was comparable between both groups; there was a tendency for a lower Rutherford classification for acute limb ischemia (ALI) in the percutaneous mechanical thrombectomy (PMT) group [category I and IIA in 82% (23/28)] than the catheter-directed thrombolysis (CDT) group [63% (56/89)] with a p value of 0.058
In the CDT group, 57% (50/89) of patients were treated for femorocrural occlusions compared to 25% (7/28) in the PMT group
Summary
Acute limb ischemia (ALI) is defined as a sudden significant decrease in limb perfusion that has been present for less than 14 days that is causing a threat to limb viability (Patel et al, 2003). To preserve viability and to reduce mortality and morbidity, early restoration of blood flow is crucial. This can be achieved by various surgical or endovascular techniques depending on the severity (Norgren et al, 2007). Acute limb ischemia is associated with significant mortality and amputation rate. Restoration of flow can be obtained by various treatment methods that include catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT). These treatments have been shown to be effective but associated with various complications. We aim to review our experience in the treatment of acute limb ischemia (ALI) and compare CDT with PMT
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