Is Surgical Thrombo-Embolectomy in Acute Limb Ischemia Still Advantageous in Patients More Than 65 Years of Age?

Objective: In this study, we investigated the benefits of using Fogarty balloon catheterization in the treatment of acute leg ischemia with respect to amputation, fasciotomy, and mortality in older patients. Methods: A total of 102 patients age >65 who had a Fogarty thrombo-embolectomy for acute thromboembolic limb ischemia were investigated retrospectively. Patients were evaluated based on Rutherford IIa and IIb criteria and duration of ischemia. Duration of ischemia was divided into 3 categories (as 0 to 4, 4 to 8, and >8 hours) to evaluate the effect of ischemia period on vital parameters and mortality. Analysis with Cox regression showed that 30-day mortality was associated with older age and number of comorbidities such as amputation and fasciotomy. Results: In 102 patients >65 years of age who underwent embolectomy, rates were 7.2% fasciotomy (n = 7) and 13.7% amputation (n = 14), and 10 patients died (9.8%). According to multiple regression analysis, the surgical risk increases 1074 times when each year is added to the chronological age of over 65 years. Conclusion: In a majority of cases, limb salvage can be obtained via simple embolectomy rather than risking intravenous iodinated contrast. Although alternatives in older patients are limited, the Fogarty catheter should be regarded as a first-line treatment because of its ease of use and low complication rate.

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Atrial Fibrillation is Associated with Femoropopliteal Totally Occlusive In-Stent Restenosis: A Single-Center, Retrospective, Observational Study

Journal of Interventional Cardiology ◽

10.1155/2021/8852466 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Yohsuke Honda ◽

Keisuke Hirano ◽

Masahiro Yamawaki ◽

Motoharu Araki ◽

Norihiro Kobayashi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

De Novo ◽

Limb Ischemia ◽

Hazard Ratio ◽

Acute Limb Ischemia ◽

Stent Occlusion ◽

Stent Restenosis ◽

Artery Disease ◽

In Stent Restenosis

Introduction. The proportion of patients with comorbid atrial fibrillation (AF) and peripheral artery disease (PAD) has increased in this era. This study aimed to assess the relationship between AF and totally occlusive in-stent restenosis (ISR) in femoropopliteal (FP) lesions. Methods. In this study, 363 patients (461 stents) who underwent endovascular therapy with de novo stent implantation in our hospital between April 2007 and December 2016 were retrospectively evaluated. The patients were divided into two groups according to the AF status (AF group, 61 patients; sinus group, 302 patients). The primary endpoint was the incidence of totally occlusive ISR within 3 years. The secondary endpoint was the incidence of acute limb ischemia (ALI) due to FP stent occlusion. Results. Baseline characteristics were similar, except for higher age and a lower prevalence of dyslipidemia in the AF group. The incidence of a totally occlusive ISR was higher in the AF group than in the sinus group (29.5% vs. 14.6%, p = 0.004 ). A multiple Cox regression model suggested that presence of AF (hazard ratio, 2.10) and CTO lesion (hazard ratio, 1.97) which were the independent predictors of a totally occlusive ISR within 3 years. The incidence of ALI was significantly higher in the AF group than in the sinus group (3.9% vs. 0%, p = 0.0001 ). In the AF group, the introduction of an anticoagulant did not prevent the occurrence of totally occlusive ISR ( p = 0.71 ) for ALI ( p = 0.79 ). Conclusions. AF is independently associated with totally occlusive ISR of FP stents; however, anticoagulant use does not prevent stent occlusion.

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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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Advanced treatment of acute femoropopliteal bypass graft occlusion with Fogarty catheter guidance

Vascular ◽

10.1177/1708538113496238 ◽

2013 ◽

Vol 22 (4) ◽

pp. 262-266 ◽

Cited By ~ 1

Author(s):

Gokhan Albayrak ◽

Koray Aykut ◽

Mehmet Guzeloglu ◽

Aytac Gulcu ◽

Eyup Hazan

Keyword(s):

Bypass Graft ◽

Limb Ischemia ◽

Graft Patency ◽

Transluminal Angioplasty ◽

Acute Limb Ischemia ◽

Graft Occlusion ◽

Fogarty Catheter ◽

Femoropopliteal Bypass ◽

Conventional Angiography ◽

Stent Grafting

Purpose The guiding role of the Fogarty catheter was investigated among patients suffering from limb ischemia due to acute femoropopliteal bypass graft occlusion. Methods A total of 27 patients with a history of femoropopliteal bypass operation who was admitted with acute limb ischemia were enrolled in this retrospective study. In cases in which the Fogarty catheter could not be passed through the popliteal anastomosis, the popliteal region was explored and a new bypass or patch plasty was performed for the distal anastomosis. The cases in which the blood circulation was observed in the graft, but in which the Fogarty catheter balloon was stuck in the native vessels on the proximal and distal side of the graft and the balloon could be withdrawn by deflation, were referred to conventional angiography. The stenosis observed in native vessels was managed by endovascular stent grafting and/or balloon dilatation. Findings Graft patency was achieved in all patients. In 11 patients, conventional angiography was implemented following embolectomy. In these patients, all the occlusions found as significant on angiography were removed by percutaneous transluminal angioplasty. Conclusion Effective use of Fogarty catheter is safe in acute femoropopliteal bypass graft occlusions and in particular, in the planning of further treatment following thrombectomy.

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Revascularization Outcomes in Patients With Acute Limb Ischemia and Active Neoplastic Disease

Journal of Endovascular Therapy ◽

10.1177/1526602820954285 ◽

2020 ◽

pp. 152660282095428

Author(s):

Angeliki Argyriou ◽

Alexandros Kafetzakis ◽

Athanasios Saratzis ◽

Bella Huasen ◽

Raphaël Coscas ◽

...

Keyword(s):

Overall Survival ◽

Cox Regression ◽

Treatment Options ◽

Limb Ischemia ◽

Free Time ◽

Neoplastic Disease ◽

Acute Limb Ischemia ◽

Cox Regression Analysis ◽

Increased Risk ◽

Common Diagnosis

Purpose To report the outcomes of surgical (ST), endovascular (ET), and hybrid (HT) treatment in cancer patients with acute limb ischemia (ALI). Materials and Methods A multicenter retrospective registry collected 139 patients (mean age 72.3±12.4 years; 73 men) with ALI and active malignancy treated by ET (41, 29%), ST (70, 51%), or HT (28, 20%) in 7 European centers between July 2007 and February 2019. In 22 cases (16%) ALI was the first manifestation of the malignancy. Lung cancer was the most common diagnosis (38, 27%). The primary composite outcome was amputation-free survival (AFS). Overall survival, amputation-free time (AFT), and reintervention-free time (RFT) were also assessed. Cox regression analysis was applied to identify independent risk factors for the primary and secondary outcomes. Results are presented as the hazard ratio (HR) and 95% confidence intervals (CIs). Results ET was associated with improved 12-month AFS compared with both ST (HR 2.27, 95% CI 1.20 to 4.28, p=0.002) and HT (HR 2.14, 95% CI 1.09 to 4.18, p=0.008). ST (HR 2.50, 95% CI 1.19 to 5.53, p=0.003) and HT (HR 3.10, 95% CI 1.45 to 6.65, p<0.001) were related to an increased risk for mortality compared with ET. At 12 months, the AFT was similar between the 3 groups (ET vs ST: HR 1.52, 95% CI 0.51 to 4.53, p=0.45 and ET vs HT: HR 1.21, 95% CI 0.36 to 4.11, p=0.73). The 12-month RFT also did not differ significantly between the 3 treatment options (ET vs ST: HR 1.10, 95% CI 0.49 to 2.46, p=0.79 and ET vs HT: HR 0.51, 95% CI 0.22 to 1.17, p=0.19). ST and/or HT increased the risk for the major amputation and/or death (HR 1.76, 95% CI 1.05 to 2.05, p=0.03), while Rutherford class I ischemia (HR 0.12, 95% CI 0.02 to 0.90, p=0.04) and previous vascular interventions on the index limb (HR 0.55, 95% CI 0.32 to 0.97, p=0.04) showed a protective effect. Conclusion In patients with ALI and active malignant disease, ET was associated with increased AFS and overall survival compared with both ST and HT, while the limb salvage and reintervention rates were comparable among the 3 groups.

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TCT-362 A novel fully percutaneous thrombectomy technique with balloon occlusion guiding catheter and over-the-wire Fogarty catheter for acute limb ischemia

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.09.453 ◽

2017 ◽

Vol 70 (18) ◽

pp. B149

Author(s):

Tomoyuki Umemoto ◽

Kensuke Hirasawa ◽

Yuji Matsuda ◽

Takashi Ashikaga

Keyword(s):

Limb Ischemia ◽

Balloon Occlusion ◽

Acute Limb Ischemia ◽

Fogarty Catheter ◽

The Wire ◽

Percutaneous Thrombectomy ◽

Guiding Catheter

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Percutaneous Mechanical Thrombectomy Using Rotarex® S Device in Acute Limb Ischemia in Infrainguinal Occlusions

BioMed Research International ◽

10.1155/2017/2362769 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 13

Author(s):

Samuel Heller ◽

Jean-Claude Lubanda ◽

Petr Varejka ◽

Miroslav Chochola ◽

Pavel Prochazka ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Limb Ischemia ◽

Performance Outcomes ◽

Amputation Rate ◽

Acute Limb Ischemia ◽

Line Treatment ◽

First Line ◽

Invasive Treatment ◽

Percutaneous Mechanical Thrombectomy ◽

First Line Treatment

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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A Case of Needle-Directed Pulse-Spray Pharmacomechanical Thrombolysis of Acute Brachial Artery Thrombosis

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-3401326 ◽

2019 ◽

Vol 03 (03) ◽

pp. 193-195

Author(s):

Yugandhar Samireddypalle ◽

Uma Maheshwara Reddy V. ◽

Chinmay Deepak ◽

Sankar Neelakantan ◽

Amitha Vikrama KS

Keyword(s):

Brachial Artery ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

First Line ◽

Management Options ◽

Artery Thrombosis ◽

Catheter Directed Thrombolysis ◽

Symptoms And Signs

AbstractAcute limb ischemia is a serious disabling condition. The management options depend upon the patient symptoms and signs of ischemia in the affected limb. The management options include surgical thrombo-embolectomy and catheter directed thrombolysis. Catheter directed thrombolysis has now become the first line of management in symptomatic cases. Here, we discuss a case of acute left brachial artery thrombosis which was successfully managed by needle-directed pulse-spray thrombolysis.

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Arterial Thrombosis Induced By Coagulopathy Due To Coronavirus Infection Concomitant With Heparin Resistance: A Case Report

Heart Science Journal ◽

10.21776/ub.hsj.2021.002.04.8 ◽

2021 ◽

Vol 2 (4) ◽

pp. 36-39

Author(s):

Irma Kamelia ◽

Heny Martini ◽

Novi Kurnianingsih ◽

Indra Prasetya

Keyword(s):

Femoral Artery ◽

Severe Pneumonia ◽

Patient Discharge ◽

Limb Ischemia ◽

High Dose ◽

Acute Limb Ischemia ◽

Fogarty Catheter ◽

Antegrade Approach ◽

Heparin Resistance ◽

The Right

Background : A newly emerging pandemic of Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 is responsible for significant morbidity and mortality worldwide. As one of the effects is hematological changes related to the COVID-19 infection causing patient tend to thrombosis than hemorrhagic. Current review of evidence and statements on management of coagulopathy and thrombotic complications related to this novel disease is needs to be explored Case : Male 53 years old referred from Private Hospital, due to Severe pneumonia due to COVID-19 and Acute Limb Ischemia. This patient was assessed as Pneumonia COVID-19 severe with acute limb ischemia bilateral grade IIB and performed bilateral surgical thrombectomy with antegrade approach using fogarty catheter with the result was thrombus 10cm along the left femoral artery and thrombus 2cm in the right femoral artery. Discussion : With consideration of atherosclerotic diseases in this patient, we decided to give rivaroxaban as an anticoagulant combined with aspilet and statin high dose. But due to lack of source in our hospital, and patient also denied for further management, treatment for the patient cannot be optimal, so the patient discharge with unresolved limb ischemia. Conclusion : This case showed that the increase risk of heparin resistance in SARS-CoV-2 patient, it is recommend- ed to monitor heparin activity of UFH treatment based on anti-Xa levels instead of aPTT alone.

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Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽

10.1024/0301-1526/a000876 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Marina Di Pilla ◽

Stefano Barco ◽

Clara Sacco ◽

Giovanni Barosi ◽

Corrado Lodigiani

Keyword(s):

Systematic Review ◽

Case Report ◽

Lower Limb ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Review Of The Literature ◽

Heparin Induced Thrombocytopenia ◽

Lower Limb Ischemia ◽

Vein Thrombosis ◽

Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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