Rheolytic thrombectomy in the management of acute and subacute limb-threatening ischemia

PURPOSE: To evaluate the use of a percutaneous mechanical thrombectomy (PMT ) catheter (AngioJet) as an initial treatment for acute (<2 weeks) and suba cute (2 weeks to 4 months) arterial occlusion of the limbs. MATERIALS AND METHODS: A total of 86 (acute, n = 65; subacute, n = 21) pati ents were available for retrospective analysis, averaging 65 +/- 14 years o f age. Outcomes assessed include initial angiographic success (failure = le ss than 50% luminal restoration [LR]; partial success = 50%-95% LR; success more than 95% LR), pre- and postprocedural ankle-brachial index (ABI), dev ice-related and systemic complications, 1-month amputation, mortality, and short-term patency. RESULTS: Angiographic success was evaluated in 83 of 86 patients (guide wir e unable to traverse lesion in three patients). The procedure failed in 13 of 83 (15.6%) patients, partial success was seen in 19 of 83 patients (22.9 %), and successful recanalization was noted in 51 of 83 patients (61.4%). A djunctive thrombolysis was used in 50 of 86 patients (58%). However, thromb olysis resulted in angiographic improvement at the site of PMT in only seve n of 50 of these patients (14%). Adjunctive thrombolysis was uniformly unsu ccessful in patients in whom initial PMT failed. The median increase in ABI was 0.64 (95% CI: 0.43-0.81). Success was more likely in the setting of in situ thrombosis, with 61 of 68 (90%) procedures successful, compared to em bolic occlusions, with nine of 15 (60%) procedures successful (P=.011). Ang iographic outcome was not dependent on the duration of occlusion (acute, 51 of 62; subacute, 19 of 21; P=.35) or the conduit type (graft, 28 of 31; na tive vessel, 42 of 52; P=.35). An underlying stenosis was identified in 53 of the 70 patients (75.7%) with a successful PMT, and 51 of these 53 unmask ed lesions were successfully treated. Follow-up data were available in 56 p atients for patency assessment at a median of 3.9 months (range, 0.1-28.5 m onths). Patency at 6 months was 79% (95% CI: 65-92). Systemic complications occurred in 16.3% of patients, local complications were noted in 18.6%, an d 1-month amputation and mortality rates were 11.6% and 9.3%, respectively. CONCLUSION: PMT offers the potential to rapidly reestablish flow to an isch emic extremity and may be the only available treatment option in patients a t high risk for open surgery or with contraindications to pharmacologic thr ombolysis.