INTRAOPERATIVE DIGITAL SUBTRACTION ANGIOGRAPHY AFTER THROMBOEMBOLECTOMY - PRELIMINARY EXPERIENCE

Purpose: To evaluate the potential influence of intraoperative digital subtraction angiography (DSA) on surgical strategy after balloon thro mboembolectomy for acute lower limb ischemia. Methods: Thirty-six cons ecutive patients with critical limb ischemia were treated with balloon catheter thromboembolectomy assessed by intraoperative digital subtra ction angiography. The need for further intervention was determined by the surgeon based on the DSA information. Primary completion DSAs wer e made in every procedure; subsequent completion DSAs were performed a fter reinterventions at the discretion of the surgeon. Results: Initia l treatment in this patient group consisted of 14 embolectomies and 26 thrombectomies. From the completion DSAs of these 40 procedures, a re intervention was judged necessary in 27 (68%). Of these 27 reintervent ions, 17 underwent a secondary DSA; evidence supporting a third interv ention was found in 11 (64%). Overall, a total of 69 DSAs were perform ed in these patients. Mortality was 22% (8 patients); 38% (5) in embol ectomy patients and 13% (3) in the thrombectomy cohort. Eighty-eight p ercent of the embolectomy survivors had an uneventful recovery, while only 25% of the thrombectomy survivors experienced an uncomplicated fo llow-up. In one quarter of the surviving thrombectomy patients, a surg ical revascularization resulted in limb salvage; in 45%, a major amput ation was the outcome. Conclusions: In this study, the completeness of balloon catheter thromboembolectomy was assessed by intraoperative DS A. As a result, 68% of the procedures required one or more reintervent ions for residual lesions. Intraoperative DSA is a simple and quick te chnique that may be a promising adjunct to intraoperative balloon thro mboembolectomy.