title: Rheolytic Pharmacomechanical Thrombectomy for the Management of Acute Limb Ischemia: Results From the PEARL Registry.
abstract: OBJECTIVE
  To present the results of rheolytic pharmacomechanical thrombectomy (PMT) for the management of acute limb ischemia (ALI) as reported in the PEARL Registry (PEripheral Use of AngioJet Rheolytic Thrombectomy with a variety of catheter Lengths).
  
  
  METHODS
  A total of 283 patients (mean age 65±13 years; 170 men) presenting with ALI undergoing treatment with the AngioJet System at participating institutions were enrolled in the registry. Rutherford ALI categories included 26% with viable limbs, 38% with marginally threatened limbs, 35% with immediately threatened limbs, and <1% with irreversible damage. Procedure and follow-up data were collected for the calculation of outcomes. To control for patient selection bias, propensity score matching was used to compare outcomes for patients undergoing PMT with or without catheter-directed thrombolysis (CDT).
  
  
  RESULTS
  Procedure success was achieved in 235 (83%) of 283 patients. Half of the procedures (147, 52%) were completed without the need for adjunctive CDT. At 12-month follow-up, amputation-free survival and freedom from mortality were 81% and 91%, respectively; 12-month freedom from bleeding requiring transfusion was 91%, and freedom from renal failure was 95%. Subgroup analysis revealed significantly better outcomes in patients without infrapopliteal involvement and those who underwent PMT without CDT. In the matched cohorts, higher rates of procedure success, 12-month amputation-free survival, and 12-month freedom from amputation were observed in the PMT without CDT group (88% vs 74%, p=0.021; 87% vs 72%, p=0.028; 96% vs 81%, p=0.01, respectively).
  
  
  CONCLUSIONS
  The results support the use of PMT as a first-line treatment for ALI, providing a rapid reperfusion to the extremity, reduced procedure time, and an acceptable risk profile without compromising limb salvage.
authors.affiliation: Christiana Care Health Services, Newark, DE, USA dleung@christianacare.org.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leung
authors.affiliation: Chilton Memorial Hospital, Pompton Plains, NJ, USA.
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Blitz
authors.affiliation: Technomics Research, LLC, Minneapolis, MN, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Nelson
authors.affiliation: Reading Hospital & Medical Center, West Reading, PA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Amin
authors.affiliation: Miriam Hospital, Providence, RI, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Soukas
authors.affiliation: Charleston Area Medical Center, Charleston, WV, USA.
authors.forename: Aravinda
authors.initials: A
authors.lastname: Nanjundappa
authors.affiliation: Christiana Care Health Services, Newark, DE, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Garcia
authors.affiliation: Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Lookstein
authors.affiliation: Pennsylvania State University and the Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Simoni
mesh_terms: D000208:Acute Disease; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D062666:Vascular Access Devices
keywords: AngioJet thrombectomy; acute limb ischemia; amputation; arterial thrombosis; catheter-directed thrombolysis; mechanical thrombectomy; mortality; rheolytic thrombectomy; thrombotic occlusion