Abstract
ObjectivesTo evaluate the effectiveness and safety of combined treatment (image guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia.MethodsFrom 2009 to 2017, 52 patients (44 men, eight women, mean 67.2 years) underwent combined treatment for acute thrombotic occlusion of lower extremity arteries. The patients presented with acute limb ischemia and we selectively perform combined treatment in the cases with challenging clinical considerations (e.g. various spectrum of thrombus, underlying atherosclerotic lesions). Combined treatment included cutdown of common femoral artery, thrombectomy using a Fogarty balloon catheter, balloon angioplasty, stenting, and catheter-introduced thrombus fragmentation and aspiration. Patients’ medical records were retrospectively reviewed and follow-up data were collected. The technical and clinical success rates and limb salvage were assessed. The Kaplan-Meier method was used to analyze primary patency rates and overall survival rates. Univariate analyses were performed to determine the factors related to clinical outcomes.ResultsTechnical and clinical success rate was 90.4% and 80.8%, respectively. The mean follow-up duration was 26.5 ± 25.8 months. Primary patency was 91.4%, 86.1%, and 74.6% at six months, 1-, and 2-year, respectively. Limb salvage without amputation was 88.5% (46/52). The overall survival rates at six months, 1-, and 3-year were 82.6%, 80.2, and 56.9%, respectively. The 30-day mortality was 5.8% (3/52). Univariate analysis showed that percutaneous transluminal angioplasty (PTA) type (balloon versus stent) was related to clinical failure.ConclusionsCombined treatment can be effective and safe for ALI patients even under challenging clinical conditions.
Highlights
Acute limb ischemia (ALI) is the sudden decrease in limb perfusion due to either an embolic or a thrombotic vascular occlusion, which is defined as the presence of symptoms within two weeks of onset [1]
The treatment approach for ALI depends on the clinical categories based on TransAtlantic Inter-Society Consensus (TASC) [3]
3) Presence of the underlying atherosclerotic lesions presumed to require percutaneous transluminal angioplasty (PTA). 4) Thrombus in a poor location that is difficult to remove by surgical thrombectomy alone
Summary
Acute limb ischemia (ALI) is the sudden decrease in limb perfusion due to either an embolic or a thrombotic vascular occlusion, which is defined as the presence of symptoms within two weeks of onset [1]. The treatment approach for ALI depends on the clinical categories based on TransAtlantic Inter-Society Consensus (TASC) [3]. Both surgical thrombectomy and endovascular treatment have benefits and drawbacks. Endovascular management (e.g. catheter-directed thrombolysis: CDT) has emerged as an alternative to surgery. It is less invasive, and does not directly damage the vascular endothelium with the capacity to clear thrombus in the small vessels. About 20% of patients have contraindications to thrombolytic therapy [6] These problems may be minimized by combined treatment, which combines surgical thrombectomy and endovascular treatment. Regarding combined treatment, there is little information as to its clinical efficacy or associated risk factors
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