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. 2018;1(1):35.
doi: 10.1186/s42155-018-0041-1. Epub 2018 Dec 3.

Catheter-directed thrombolysis versus percutaneous mechanical thrombectomy in the management of acute limb ischemia: a single center review

Ravi Kumar Muli Jogi  1   2 , Karthikeyan Damodharan  1 , Hing Lun Leong  1 , Allison Chek Swee Tan  1 , Sivanathan Chandramohan  1 , Nanda Kumar Karaddi Venkatanarasimha  1 , Farah Gillan Irani  1 , Ankur Patel  1 , Apoorva Gogna  1 , Kiang Hiong Tay  1 , Thijs August Johan Urlings  1
Affiliations

Catheter-directed thrombolysis versus percutaneous mechanical thrombectomy in the management of acute limb ischemia: a single center review

Ravi Kumar Muli Jogi et al. CVIR Endovasc. 2018.

Abstract

Background: Acute 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.

Results: A 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).

Conclusion: PMT 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.

Keywords: Acute limb ischemia; Thrombectomy; Thrombolysis.

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Conflict of interest statement

This study was approved by the Institutional Review board. The need for consent was waived.not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Ansel GM, Botti CF, Silver MJ. Treatment of acute limb ischaemia with a percutaneous mechanical thrombectomy-based endovascular approach: 5 year limb salvage and survival results from a single center series. Catheter Cardiovasc Interv. 2008;72(3):325–330. doi: 10.1002/ccd.21641. - DOI - PubMed
    1. Byrne RM, Taha AG, Avgerinos E, et al. Contemporary outcomes of endovascular interventions for acute limb ischemia. J Vasc Surg. 2014;59(4):988–995. doi: 10.1016/j.jvs.2013.10.054. - DOI - PubMed
    1. Dormandy J, Heeck L, Vig S. Acute limb ischaemia. Semin Vas Surg. 1999;12:148–153. - PubMed
    1. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the Cirse classification system. Cardiovasc Intervent Radiol. 2017;40(8):1141–1146. doi: 10.1007/s00270-017-1703-4. - DOI - PubMed
    1. Karnabatidis D, Spiliopoulos S, Tsetis D, et al. Quality improvement guidelines for percutaneous catheter directed intra-arterial thrombolysis and mechanical thrombectomy for acute limb ischaemia. Cardiovasc Intervent Radiol. 2011;34:1123–1136. doi: 10.1007/s00270-011-0258-z. - DOI - PubMed

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