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

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

Journal of Cardiology & Current Research ◽

10.15406/jccr.2016.07.00242 ◽

2016 ◽

Vol 7 (2) ◽

Keyword(s):

Limb Salvage ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Catheter Directed Thrombolysis

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Outcomes of Catheter-Directed Thrombolysis in Patients with Acute Arterial Thrombotic Limb Ischemia: A Prospective Interventional Case Series

Frontiers in Emergency Medicine ◽

10.18502/fem.v5i3.5896 ◽

2021 ◽

Author(s):

Javad Salimi ◽

Ehsan Rahimpour ◽

Hossein Zabihi Mahmoudabadi ◽

Pezhman Farshidmehr

Keyword(s):

Success Rate ◽

Treatment Success ◽

Case Series ◽

Pulmonary Hemorrhage ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Technical Success Rate ◽

Catheter Directed Thrombolysis ◽

One Year

Introduction: Acute limb ischemia is a critical medical condition that can quickly become a life threat. Therapeutic modalities such as catheter-directed thrombolysis (CDT) have demonstrated various levels of efficacy in previous studies. Objective: This study presents the descriptive findings of a series of cases who presented with acute arterial thrombotic limb ischemia and underwent CDT. Methods: This was a cross-sectional single-hospital-based case series, in which all patients who were diagnosed with acute arterial thrombotic limb ischemia, and consequently underwent CDT during the oneyear study period were included. Detailed baseline characteristics and clinical findings of the studied patients on presentation, after intervention and at one-year follow-up are presented. Results: A total of 21 patients with a mean age of 60.7±15.2 years, including 16 males (76.2%) were included. The initial technical and treatment success rates were 20 (95.2%) and 14 (66.7%), respectively. The amputation-free and the overall survival rates after the one-year follow-up were 15 (71.4%) and 17 (81%), respectively. Four patients (19%) developed complications, two (9.5%) of which were significant (pulmonary hemorrhage and intraventricular hemorrhage). Amputation was performed in 6 (28.6%) cases. Conclusion: In this study, the treatment success rate and the technical success rate were satisfactory.

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Outcomes of limb and life in patients with acute lower limb ischema presenting before and after the “golden six hours”

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20182498 ◽

2018 ◽

Vol 5 (4) ◽

pp. 788 ◽

Cited By ~ 1

Author(s):

Murali Krishna Nekkanti ◽

Vivekanand . ◽

Kalkunte R. Suresh ◽

Vishnu Motukuru ◽

Sumanthraj Kolalu ◽

...

Keyword(s):

Limb Salvage ◽

Lower Limb ◽

Physiological State ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Delayed Presentation ◽

Class Iii ◽

Potential Threat ◽

Irreversible Damage ◽

Catheter Directed Thrombolysis

Background: Acute limb ischemia (ALI) is any sudden decrease in limb perfusion causing a potential threat to limb viability. It is generally accepted that in a patient without underlying arterial disease who develops an acute arterial blockage has approximately six hours for revascularisation before irreversible damage occurs. This study endeavoured to analyse and evaluate the causes and clinical outcome of acute lower limb ischemia.Methods: 80 successive patients visiting Jain Institute of Vascular Sciences, Bangalore who were diagnosed to have ALI were included in this prospective study. Thromboembolectomy was performed in 48% of patients, 9% of patients were managed with anticoagulation alone, 8% of patients were treated by catheter directed thrombolysis and primary amputation was inevitable in 16 patients of class III ischemia.Results: All the five patients who presented within the golden six hours survived and their limbs could be salvaged without any morbidity. Even in patients with delayed presentation but viable limb (47 patients) functional limb salvage was possible in 39 patients (82.9%). Overall there was 72.73% limb salvage and 27.27% patients underwent amputation. There was a mortality rate of 13.16% in the study.Conclusions: Overall there was 72.73% limb salvage and 27.27% patients underwent amputation. Revascularization within six hours is ideal (only 6.25% of patients in our study); however, in delayed presentation (93.75%), physiological state of the limb, rather than elapsed time from onset of occlusion will determine the operability. Late revascularization may thus be indicated and is often successful if limb still exhibits signs of viability.

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Comparison of Ultrasound-Accelerated Versus Multi-Hole Infusion Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia

Vascular and Endovascular Surgery ◽

10.1177/1538574419861768 ◽

2019 ◽

Vol 53 (7) ◽

pp. 558-562 ◽

Cited By ~ 2

Author(s):

Jesse Chait ◽

Afsha Aurshina ◽

Natalie Marks ◽

Anil Hingorani ◽

Enrico Ascher

Keyword(s):

Success Rate ◽

Limb Ischemia ◽

Limb Loss ◽

Acute Limb Ischemia ◽

Technical Success ◽

Safety And Efficacy ◽

Technical Success Rate ◽

Infusion Catheter ◽

Catheter Directed Thrombolysis ◽

The Mean

Objective: Thrombolytic therapy is widely used in the treatment of arterial occlusions causing acute limb ischemia (ALI); however, knowledge regarding the efficacy of the different catheter systems available is scarce. The objective of this study was to compare the safety and efficacy of 2 catheter-directed infusion systems for intra-arterial thrombolysis in the setting of ALI. Methods: A retrospective analysis was conducted to study all catheter-directed thrombolysis procedures performed over 32 months in patients diagnosed with ALI. Patients with thrombosis in both native arteries and bypass grafts were included. Patients with contraindications to thrombolysis, or those receiving thrombolysis for deep venous thrombosis, were excluded. The duration of thrombolysis, amount of thrombolytic agent, and technical success rate were recorded. Technical success was defined as complete or near-complete resolution of thrombus burden, allowing for further intervention. Data were stratified to include location of thrombus, procedural complications, mortality, and rates of limb loss. Results: Ninety-one patients met inclusion criteria. Among them, Uni-Fuse and EKOS catheters were used in 69 and 22 patients, respectively. The mean age of the population was 71 (standard deviation [SD]: ±1.5) for patients treated with the EKOS catheter and 70 years (SD: ±2.6) for patients receiving thrombolysis with Uni-Fuse. There was no significant difference in the mean infusion duration (1.65 vs 1.9 days), volume of tissue plasminogen activator (44.6 vs 48.2 mg), or technical success rate (72% vs 86%) between the Uni-Fuse and EKOS cohorts ( P > .3). Furthermore, there was no difference in major limb loss or compartment syndrome between each group ( P > .4). The overall complication rate was 14% in both groups, with a 30-day mortality rate of 4% when treated with either catheter system. Conclusion: This study suggests that a standard multi-hole infusion catheter demonstrates similar clinical safety and efficacy as the ultrasound-accelerated EKOS system in the treatment of ALI.

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Clinical outcomes of surgical embolectomy versus catheter-directed thrombolysis for acute limb ischemia: a nationwide cohort study

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-021-02532-1 ◽

2021 ◽

Author(s):

Po-Kai Yang ◽

Chien-Chou Su ◽

Chih-Hsin Hsu

Keyword(s):

Rate Ratio ◽

Surgical Intervention ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Antithrombotic Agent ◽

Catheter Directed Thrombolysis ◽

Significant Difference ◽

Surgical Embolectomy ◽

Adjusted Rate ◽

Adjusted Rate Ratio

AbstractIn Taiwan, the outcomes of acute limb ischemia have yet to be investigated in a standardized manner. In this study, we compared the safety, feasibility and outcomes of acute limb ischemia after surgical embolectomy or catheter-directed therapy in Taiwan. This study used data collected from the Taiwan’s National Health Insurance Database (NHID) and Cause of Death Data between the years 2000 and 2015. The rate ratio of all-cause in-hospital mortality and risk of amputation during the same period of hospital stay were estimated using Generalized linear models (GLM). There was no significant difference in mortality risk between CDT and surgical intervention (9.5% vs. 10.68%, adjusted rate ratio (95% CI): regression 1.0 [0.79–1.27], PS matching 0.92 [0.69–1.23]). The risk of amputation was also comparable between the two groups. (13.59% vs. 14.81%, adjusted rate ratio (95% CI): regression 0.84 [0.68–1.02], PS matching 0.92 [0.72–1.17]). Age (p < 0.001) and liver disease (p = 0.01) were associated with higher mortality risks. Heart failure (p = 0.03) and chronic or end-stage renal disease (p = 0.03) were associated with higher amputation risks. Prior antithrombotic agent use (p = 0.03) was associated with a reduced risk of amputation. Both surgical intervention and CDT are effective and feasible procedures for patients with ALI in Taiwan.

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RR20. Ultrasound-Accelerated Thrombolysis is Superior to Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.03.206 ◽

2011 ◽

Vol 53 (6) ◽

pp. 106S-107S

Author(s):

Maria E. Litzendorf ◽

Jean E. Starr ◽

Bhagwan Satiani ◽

Katherine E. Notter

Keyword(s):

Limb Ischemia ◽

Acute Limb Ischemia ◽

Catheter Directed Thrombolysis

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Catheter directed thrombolysis for acute limb ischemia: eight cases in two years

Cardiologia Croatica ◽

10.15836/ccar.2014.185 ◽

2014 ◽

Vol 9 (5-6) ◽

pp. 185-185

Author(s):

Majda Vrkic Kirhmajer ◽

Ljiljana Banfic ◽

Kresimir Putarek ◽

Miroslav Krpan ◽

Savko Dobrota ◽

...

Keyword(s):

Limb Ischemia ◽

Acute Limb Ischemia ◽

Catheter Directed Thrombolysis

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The Role of Catheter Directed Thrombolysis on Acute Limb Ischemia (an Evidence-Based Case Report)

Jurnal llmu Bedah Indonesia ◽

10.46800/jibiikabi.v49i1.79 ◽

2021 ◽

Vol 49 (1) ◽

pp. 3-24

Author(s):

Ali Farhan Fathoni ◽

Raden Suhartono

Keyword(s):

Case Report ◽

Adult Patient ◽

Controlled Trial ◽

Limb Ischemia ◽

Evidence Based ◽

Acute Limb Ischemia ◽

First Line ◽

Bleeding Events ◽

Catheter Directed Thrombolysis ◽

Significant Difference

Introduction. Acute limb ischemia can be managed both with surgery and thrombolysis, especially catheter-directed thrombolysis. The risk, benefit and indication of thrombolysis is already well known. However, as a first line therapy, it is unclear which intervention is more beneficial; the catheter directed thrombolysis or surgery. This report aims to elucidate which technique is more effective and safer. Method. This is an Evidence-Based Case Report based on a case of a geriatric, diabetic patient whom suffered acute limb ischemia. The report systematically search for meta-analysis, systematic review, randomized controlled trial and cohort studies from Cochrane central and PubMed for all adult patient suffering from acute limb ischemia whose are treated with catheter-directed thrombolysis or surgery as first-line intervention and comparing the outcome in terms of efficacy (clinical outcome such as patency and amputation-free rates) and safety (mortality and morbidity). Results. Subjects’ characteristics should be placed first to draw the demography. Put the study finding(s) here with no interpretation. For all adult patient regardless of their diabetic status and age there is no statistically significant difference for limb salvage, amputation, and mortality between two technique, however catheter directed thrombolysis showed reduced need for additional intervention whilst increasing risk of bleeding events. Conclusion. Neither techniques are more superior than the other but catheter-directed thrombolysis can be considered given that it reduce the need for further intervention, less invasive and even though it has risks for bleeding complication it is still lower compared to systemic thrombolysis. The selection of which technique can be up to clinician’s discretion in consideration of risk and benefit for each patient.

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