Ultrasound-Accelerated Thrombolysis has Higher Success and Limb Salvage Rates and Similar Costs Compared to Catheter-Directed Thrombolysis for Acute Limb Ischemia

Abstract

gdfh: Ultrasound-accelerated thrombolysis (UAT) has become an alternative to catheter-directed thrombolysis (CDT) for the treatment of acute limb ischemia. The purpose of this study was to compare outcomes and hospital costs for these two treatments. Methods: The records of all patients treated with UAT (using the EkoSonic Endovascular System, EKOS Corp, Bothell, Washington) and CDT (standard side-hole catheter) at a single institution from January 2007 through December 2010 were reviewed. Patient demographics, treatment times, procedural outcomes, complications, lengths of stay, and hospital economic data were analyzed. Results: A total of 85 patients were treated; 43 underwent UAT and 42 had CDT. Both treatment groups had similar comorbidities and prior vascular procedures. Overall, 85.9% had a previous vascular procedure with 52 prosthetic bypass grafts. UAT was successful in 41/43 patients (95.3%), whereas CDT was successful in 28/42 (66.7%, P=.0019). Median total treatment time for the UAT group was 21.29 hours versus 56.53 hours for the CDT group (P=.000). Length of stay was also less for the UAT group (5.65 vs 8.26 days, P=.027). 30-d amputation rate was significantly higher in the CDT group (42.9% vs 18.6%, P<.01). There was a significantly higher bleeding rate in the CDT (23.8% vs 4.7%, P<.01). Total procedural costs were similar for both groups ($18,270 for UAT vs $16,650 for CDT, P=.366), as were total admission direct costs ($19,556 for UAT vs $18,520 for CDT, P=.685). Conclusion: UAT has higher success rates, shorter treatment times, higher limb salvage, less bleeding complications, and shorter lengths of stay than patients undergoing CDT. Despite the favorable clinical outcome for UAT, total procedural costs and total admission direct costs remain similar. Our institution has chosen to employ standardized techniques using UAT in order to improve outcomes and decrease complications in the future.Objectives: Ultrasound-accelerated thrombolysis (UAT) has become an alternative to catheter-directed thrombolysis (CDT) for the treatment of acute limb ischemia. The purpose of this study was to compare outcomes and hospital costs for these two treatments. Methods: The records of all patients treated with UAT (using the EkoSonic Endovascular System, EKOS Corp, Bothell, Washington) and CDT (standard side-hole catheter) at a single institution from January 2007 through December 2010 were reviewed. Patient demographics, treatment times, procedural outcomes, complications, lengths of stay, and hospital economic data were analyzed. Results: A total of 85 patients were treated; 43 underwent UAT and 42 had CDT. Both treatment groups had similar comorbidities and prior vascular procedures. Overall, 85.9% had a previous vascular procedure with 52 prosthetic bypass grafts. UAT was successful in 41/43 patients (95.3%), whereas CDT was successful in 28/42 (66.7%, P=.0019). Median total treatment time for the UAT group was 21.29 hours versus 56.53 hours for the CDT group (P=.000). Length of stay was also less for the UAT group (5.65 vs 8.26 days, P=.027). 30-d amputation rate was significantly higher in the CDT group (42.9% vs 18.6%, P<.01). There was a significantly higher bleeding rate in the CDT (23.8% vs 4.7%, P<.01). Total procedural costs were similar for both groups ($18,270 for UAT vs $16,650 for CDT, P=.366), as were total admission direct costs ($19,556 for UAT vs $18,520 for CDT, P=.685). Conclusion: UAT has higher success rates, shorter treatment times, higher limb salvage, less bleeding complications, and shorter lengths of stay than patients undergoing CDT. Despite the favorable clinical outcome for UAT, total procedural costs and total admission direct costs remain similar. Our institution has chosen to employ standardized techniques using UAT in order to improve outcomes and decrease complications in the future.