Treatment of acute limb ischemia with a percutaneous mechanical thrombectomy-based endovascular approach: 5-year limb salvage and survival results from a single center series.
OBJECTIVE
The study evaluated long-term limb salvage and survival of an endovascular approach that incorporates mechanical thrombectomy (PMT) in the management of arterial thrombosis.


BACKGROUND
Acute limb ischemia is associated with a high risk of amputation and death. Previous reports from the United States (U.S.) of surgical and nonsurgical treatments are limited to primarily 30 days to 1 year.


METHODS
Single-center, retrospective review of 57 consecutive patients (30 male, 27 female; mean age 63.8 +/- 13.8 years) treated for limb threatening ischemia due to thrombotic arterial occlusions. Data includes baseline assessments, procedural outcomes, in-hospital complications, 30-day, and long-term follow-up.


RESULTS
Ninety-three percent of patients (n = 53) presented with onset of symptoms (<14 days). Angiography following PMT showed thrombus removal complete/substantial 36 (63.6%), partial 16 (28.0%), and minimal 5 (8.8%), respectively. Catheter-directed thrombolysis was used after PMT in 18 patients (31.6%). In-hospital success with limb salvage was attained in 96.5% (n = 55) with mortality of 3.5% (n = 2). Thirty-day limb salvage and mortality were 94.7% (n = 54) and 5.3% (n = 3), respectively. At mean 5-year follow-up (mean = 62 months), three patients have been lost to follow-up. The results of 54/57 (94.7%) are available. Amputation free survival was 94.7% (n = 36/38) with long-term mortality rate of 29.6% (n = 16/54).


CONCLUSIONS
Acute limb ischemia treated with PMT alone or in combination with thrombolysis, followed by definitive therapy, results in favorable long-term limb salvage. Allowing for appreciable long-term mortality in vascular patients, survivors demonstrate amputation-free success from the initial endovascular procedure with low reintervention rate.
Ansel
Gary M
GM
Midwest Cardiology Research Foundation, Mid-Ohio Cardiology Consultants, Inc., 3545 Olentangy River Road, Suite 325, Columbus, Ohio.
Botti
Charles F
CF
Midwest Cardiology Research Foundation, Mid-Ohio Cardiology Consultants, Inc., 3545 Olentangy River Road, Suite 325, Columbus, Ohio.
Silver
Mitchell J
MJ
Midwest Cardiology Research Foundation, Mid-Ohio Cardiology Consultants, Inc., 3545 Olentangy River Road, Suite 325, Columbus, Ohio.
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005121:Extremities / Q000098:blood supply*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome