Limb Salvage Does Not Predict Functional Limb Outcome after Revascularization for Traumatic Acute Limb Ischemia

Abstract Severe limb ischemia represents a critical condition, being associated with high morbidity and mortality rates. Patients with critical limb ischemia (CLI) require urgent initiation of interventional or surgical treatment, as restoration of the blood flow is the only way to ensure limb salvage in these critical cases. At the same time, in acute limb ischemia, a dramatic form of sudden arterial occlusion of the lower limbs, the integrity of the limb is also seriously threatened in the absence of urgent revascularization. From patients with CLI, 40% are “no option CLI”, meaning patients in whom, due to anatomical considerations or to the severity of the lesions, there is no possibility to perform interventional or surgical treatment or they have failed. Therapeutic angiogenesis has been proposed to serve as an effective and promising alternative therapy for patients with severe limb ischemia who do not have any other option for revascularization. This review aims to present the current status in therapeutic angiogenesis and the role of different approaches (gene or cell therapy, intra-arterial vs. intramuscular injections, different sources of cells) in increasing the rates of limb salvage in patients with severe ischemia of the lower limbs.

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Endovascular Revascularization Strategies Using Catheter-Based Thrombectomy Versus Conventional Catheter-Directed Thrombolysis for Acute Limb Ischemia

10.21203/rs.3.rs-733076/v1 ◽

2021 ◽

Author(s):

Maofeng Gong ◽

Xu He ◽

Boxiang Zhao ◽

Jie Kong ◽

Jianping Gu ◽

...

Keyword(s):

Limb Salvage ◽

Clinical Success ◽

Limb Ischemia ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Clinical Event ◽

Comparable Efficacy ◽

Acute Limb Ischemia ◽

Technical Success Rate ◽

Catheter Directed Thrombolysis

Abstract Background Acute limb ischemia (ALI) is an important clinical event threatening both life and the affected limbs, but the optimal treatment for ALI remains undefined. The aim of this study was to compare the safety and effectiveness of thrombectomy approaches via either catheter-based thrombectomy (CBT) or catheter-directed thrombolysis (CDT). Methods A total of 98 patients (mean age 69.7 years, 60 male) who underwent endovascular intervention for ALI from January 2015 to August 2018 were included. Of these, 57 were treated with primary CBT via a large-bore catheter, an AngioJet catheter or Rotarex catheter, and/or underwent low-dose CDT, and 41 were treated with primary CDT. The safety and effectiveness of CBT compared to conventional CDT and other various endovascular techniques were evaluated. Results More Rutherford IIb patients were treated with primary CBT (68.4%) than CDT (26.8%; P < .001). Patients who underwent primary CBT achieved a higher technical success rate than those who underwent primary CDT in a shorter procedure time (P < .001), whereas 42.1% of patients who underwent CBT did not need adjunctive CDT. The duration and dosage of adjunctive CDT in the CBT group were significantly decreased compared with those in the primary CDT group (both P < .001), and the CBT group achieved a shorter in-hospital length of stay (P < .001). Subgroup analysis revealed that patients treated with AngioJet and Rotarex catheters achieved slightly lower dosages, shorter CDT durations and shorter in-hospital stay lengths than those treated with large-bore catheters (P > .05). Clinical success was estimated to be achieved in 98.2% of patients who underwent CBT, which is similar to the 97.6% estimated in those who underwent primary CDT (P = 1.000), and this finding was similar among the CBT subgroups. Patients who underwent primary CBT had slightly fewer complications than those who underwent primary CDT (P = .059), especially minor complications (P = .036). The freedom from amputation at 6 and 12 months for CBT and CDT was assessed (93.0% vs 90.2% respectively, P = .625; 89.5% vs 82.5%, respectively, P = .34,). Comparable limb salvage was found for different techniques of large bore catheters, AngioJet catheters and Rotarex catheters. The Kaplan-Meier table analysis also showed similar limb salvage rates between groups. Conclusions Endovascular treatment of ALI with the use of catheter-based therapies is a safe and effective modality with similar safety and clinical outcome to conventional CDT alone, and this treatment modality overcomes the common shortcomings of CDT alone. Different CBT techniques have comparable efficacy but different adverse event profiles.

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An Observational Study on Patients with Acute Limb Ischemia and SARS-CoV-2 Infection: Early and Late Results in Limb Salvage Rate

Journal of Clinical Medicine ◽

10.3390/jcm10215083 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5083

Author(s):

Sorin Barac ◽

Roxana Ramona Onofrei ◽

Petru Vlad Neagoe ◽

Alexandra Ioana Popescu ◽

Stelian Pantea ◽

...

Keyword(s):

Survival Rate ◽

Observational Study ◽

Limb Salvage ◽

Open Surgery ◽

Limb Ischemia ◽

Late Results ◽

Acute Limb Ischemia ◽

Free Survival ◽

Risk Of Death ◽

Revascularization Procedures

An observational study on 22 patients presenting with acute limb ischemia and SARS-CoV-2 infection, and without any other embolic risk factors, was performed. All patients were classified according to Rutherford classification for acute limb ischemia. The primary goal of this study was to assess the risk of amputation in these patients after revascularization procedures. The secondary goal was to find the correlation between acute limb ischemia (ALI) severity, patient comorbidities, risk of death, and the association of SARS-CoV-2 infection. The patients were treated by open surgery (18 patients—81.81%) or by the means of endovascular techniques (four patients—18.18%). The amputation-free survival rate was 81.81% in hospital and 86.36% at 1-month follow-up. In this study, the presence of SARS-CoV-2 infection did not influence the amputation-free survival rate: it was only the risk factor for the arterial thrombosis and the trigger for the acute ischemic event. The application of the standard treatment—open surgery or endovascular revascularization—in patients with acute limb ischemia and SARS-CoV-2 infection represents the key to success for lower limb salvage.

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Endovascular revascularization strategies using catheter-based thrombectomy versus conventional catheter-directed thrombolysis for acute limb ischemia

Thrombosis Journal ◽

10.1186/s12959-021-00349-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Maofeng Gong ◽

Xu He ◽

Boxiang Zhao ◽

Jie Kong ◽

Jianping Gu ◽

...

Keyword(s):

Limb Salvage ◽

Economic Cost ◽

Limb Ischemia ◽

Hospital Length Of Stay ◽

Clinical Event ◽

Comparable Efficacy ◽

Acute Limb Ischemia ◽

Technical Success Rate ◽

Similar Clinical Outcome ◽

Catheter Directed Thrombolysis

Abstract Background Acute limb ischemia (ALI) is an important clinical event threatening both life and the affected limbs, but the optimal treatment for ALI remains undefined. The aim of this study was to compare the safety and effectiveness of thrombectomy approaches via either catheter-based thrombectomy (CBT) or catheter-directed thrombolysis (CDT). Methods A total of 98 patients (mean age 69.7 years, 60 male) who underwent endovascular intervention for ALI from January 2015 to July 2019 were included. Of these, 57 were treated with primary CBT via a large-bore catheter, an AngioJet catheter or Rotarex catheter, and/or underwent low-dose CDT, and 41 were treated with primary CDT. The safety and effectiveness of CBT compared to conventional CDT and other various endovascular techniques were evaluated. Results More Rutherford IIb patients were treated with primary CBT (68.4%) than CDT (26.8%; P < .001). Patients who underwent primary CDT achieved a higher technical success rate than those who underwent primary CBT in a shorter procedure time (P < .001), whereas 42.1% of patients who underwent CBT did not need adjunctive CDT. The duration and dosage of adjunctive CDT in the CBT group were significantly decreased compared with those in the primary CDT group (both P < .001), and the CBT group achieved a shorter in-hospital length of stay (P < .001). Subgroup analysis revealed that patients treated with AngioJet and Rotarex catheters achieved slightly lower dosages, shorter CDT durations and shorter in-hospital stay lengths than those treated with large-bore catheters (P > .05). Clinical success was estimated to be achieved in 98.2% of patients who underwent CBT, which is similar to the 97.6% estimated in those who underwent primary CDT (P = 1.000), and this finding was similar among the CBT subgroups. Patients who underwent CBT had a higher procedure-related distal embolization rate and economic cost than those who underwent primary CDT (P < .05), but it had slightly fewer complications than those who underwent primary CDT (P = .059), especially minor complications (P = .036). The freedom from amputation at 6 and 12 months for CBT and CDT was assessed (93.0% vs 90.2% respectively, P = .625; 89.5% vs 82.9%, respectively, P = .34,). Comparable limb salvage was found for different techniques of large bore catheters, AngioJet catheters and Rotarex catheters. The Kaplan-Meier table analysis also showed similar limb salvage rates between groups. Conclusions Endovascular treatment of ALI with the use of catheter-based therapies is an effective modality that can reduce the requirement for thrombolysis, with expected reductions in hemorrhagic complications, but at the risk of remediable distal emboli and increased economic cost. It has a similar clinical outcome to conventional CDT alone. Different CBT techniques have comparable efficacy but different adverse event profiles.

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