Rheolytic thrombectomy in the management of limb ischemia: 30-day results from a multicenter registry.
OBJECTIVE
To evaluate the use of rheolytic thrombectomy (RT) with the AngioJet catheter for treatment of lower extremity ischemia due to arterial/graft thrombotic occlusion.


METHODS
A retrospective multicenter review was performed of 99 consecutive patients (52 men; mean age 67 +/- 13 years, range 30-90) who underwent RT for thrombotic occlusions in native arteries (n=80) or bypass grafts (n=19). Pre- and postprocedural limb ischemia and in-hospital events were evaluated. Amputation and mortality rates at 30 days were determined.


RESULTS
The majority of patients (78.8%) presented within 14 days of symptom onset. RT resulted in substantial to complete thrombus removal in 70 (70.7%) patients and partial in 22 (22.2%); there was no angiographic change in 7 (7.1%). Adjunctive post RT thrombolysis was used in 37 patients. Underlying stenoses found in 81 limbs were treated with one or more of the following procedures: balloon angioplasty (n=62), stenting (n=35), or nonemergent surgical revision (n=5). In-hospital complications included 2 major amputations, 5 cases of minor tissue loss, 7 rethromboses, and 3 cases of transient renal insufficiency. Four (4.0% patients died in-hospital; the 95 surviving patients all had viable limbs at discharge. Mortality and amputation rates at 30 days were 7.1% and 4.0%, respectively.


CONCLUSIONS
Percutaneous treatment of thrombotic occlusions with RT, followed by definitive treatment of the underlying stenosis, is a promising therapeutic option for patients with limb-threatening ischemia.
Ansel
Gary M
GM
MidWest Cardiology Research Foundation, Mid-Ohio Cardiology Consultants, Columbus, Ohio 43214, USA. gma@mocc.cc
George
Barry S
BS
Botti
Charles F
CF
McNamara
Thomas O
TO
Jenkins
J Stephen
JS
Ramee
Steven R
SR
Rosenfield
Kenneth
K
Noethen
Alice A
AA
Mehta
Tejas
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012212:Rheology; D017131:Thrombectomy / Q000379:methods; D013927:Thrombosis / Q000601:surgery*; D016896:Treatment Outcome