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

Purpose. To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. Methods. In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis. Additional fibrinolysis and adjunctive aspirational thrombectomy were utilized for outflow occlusion when required. Procedural outcomes, amputation rate, and mortality at 30 days were evaluated. Results. Of the 147 patients treated with mechanical thrombectomy, Rotarex S was used as first-line treatment in 120 cases and as second-line treatment in 27 cases. Overall, we achieved 90.5% procedural revascularization success rate when combining mechanical thrombectomy with limited thrombolysis for severe outflow obstruction, and 1 death and 3 amputations were observed. We achieved primary success in 68.7% of the patients with the mechanical thrombectomy only, and in 21.8% of the patients, we successfully used additional limited thrombolysis in the outflow. The overall mortality was 0.7% and amputation rate was 2% at 30 days. Conclusion. Percutaneous mechanical thrombectomy as first-line mini-invasive treatment in infrainguinal ALI is safe, quick, and effective, and the performance outcomes can be superior to that of traditional surgical embolectomy.

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Revascularization of Acute Limb Ischemia

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/jaci.v6i2.631 ◽

2020 ◽

Vol 6 (2) ◽

pp. 142-148

Author(s):

Budi Yuli Setianto ◽

Ahmad Faisal

Keyword(s):

Surgical Therapy ◽

Mechanical Thrombectomy ◽

Limb Ischemia ◽

Selection Method ◽

Medical Emergency ◽

Acute Limb Ischemia ◽

Catheter Directed Thrombolysis

Acute limb ischemia (ALI) is a medical emergency which can lead to loss of limb and even death. The outcomes are depending on the immediacy and completeness of revascularization or reperfusion. Generally, the considered a golden period in the management ALI is 6 hours. Unfortunately, the handling of patients with ALI is often too late. Currently there are several methods of revascularization such as thrombolysis (catheter directed thrombolysis), percutaneous and open surgical mechanical thrombectomy. The selection method where is the best revascularization remains controversial. Some research suggest that outcomes did not differ between thrombolysis and surgical therapy.

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A new device for percutaneous mechanical thrombectomy in acute limb ischemia

Cardiovascular Intervention and Therapeutics ◽

10.1007/s12928-011-0052-5 ◽

2011 ◽

Vol 26 (2) ◽

pp. 166-171 ◽

Cited By ~ 1

Author(s):

Yukiko Honma ◽

Kazushi Urasawa ◽

Katsuhiko Sato ◽

Ryoji Koshida

Keyword(s):

Mechanical Thrombectomy ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Percutaneous Mechanical Thrombectomy ◽

New Device

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COVID-19 Related Acute Lower Limb Ischemia Treated Via Percutaneous Thrombectomy and Catheter Direct Thrombolisis

Angiology & Vascular Surgery ◽

10.24966/avs-7397/100080 ◽

2021 ◽

Vol 6 (3) ◽

pp. 1-7

Author(s):

Francesco De Santis ◽

Keyword(s):

Popliteal Artery ◽

Lower Limb ◽

Mechanical Thrombectomy ◽

Limb Ischemia ◽

High Rate ◽

Lower Limb Ischemia ◽

Percutaneous Mechanical Thrombectomy ◽

Selective Approach ◽

Catheter Directed Thrombolysis ◽

Angio Ct

Background: The aim of this report is to describe and discuss a unique case of acute lower limb ischemia presented in a recovered COVID-19 patient treated via percutaneous mechanical thrombectomy and catheter directed thrombolysis. Starting from this singular case a wide literature review regarding COVID-19-related thrombo-embolic complications has been accomplished. Methods: A 47-year-old male was admitted to the emergency unit with acute lower limb ischemia three weeks after testing positive for COVID-19. He had been isolated at home because of minor COVID-19-related symptoms. Angio-CT-imaging showed a segmental occlusion of the common iliac artery coupled with retro-articular popliteal artery and leg vessels thrombosis. The patient was first unsuccessfully submitted to trans-femoral iliac thrombo-embolectomy. Results: Instead of peripheral limb vessel re-thromboembolectomy, a percutaneous mechanical thrombectomy coupled with leg vessel catheter direct thrombolysis was performed. The completion angiography showed the recanalization of the popliteal artery and leg vessels as far as the ankle but with a reduced forefoot vascularization. The fibrinolytic treatment was continued for 8 hours post-operatively. A compartment syndrome complicated the early post-operative course. There was a progressive recovery of ischemic symptoms and at 6-month follow-up, peripheral pulses were palpable with an almost complete normalization of foot and toe perfusion and motility. Conclusion: Acute lower limb ischemia following COVID-19-related arterial thrombo-embolic events represents a severe complication of COVID-19 infection and may result in a high rate of revascularization failure. In these cases, Percutaneous Mechanical thrombectomy coupled with catheter directed thrombolysis might represent a less traumatic and more selective approach.

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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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Treatment of acute limb ischemia with focus on endovascular techniques

VASA ◽

10.1024/0301-1526.38.2.123 ◽

2009 ◽

Vol 38 (2) ◽

pp. 123-134 ◽

Cited By ~ 10

Author(s):

Zeller ◽

Tepe

Keyword(s):

Randomized Trials ◽

Mechanical Thrombectomy ◽

Clinical Presentation ◽

Patient Survival ◽

Treatment Options ◽

Limb Ischemia ◽

Bleeding Complications ◽

Acute Limb Ischemia ◽

Endovascular Techniques ◽

Local Lysis

Acute limb ischemia is still the most frequent cause of major limb loss. Timely and fast revascularization is the key for limb salvage and patient survival. Large randomized trials showed equivalency of surgical and endovascular revascularization by means of local lysis with urokinase (TOPAS, STILE). New lytic agents and their modified application such as via a pulse spray catheter or combined with an ultrasound catheter and the combination with glycoprotein IIb/IIIa receptor antagonists have increased the efficacy and speed of thrombolysis. Recently, mechanical thrombectomy devices have become more widespread because intervention time and bleeding complications can be reduced. This review article summarizes the clinical presentation of and the treatment options for acute arterial occlusive disease caused either by embolism or local thrombosis.

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