Percutaneous mechanical thrombectomy in acute and subacute lower-extremity ischemia: impact of adjunctive, solely nonthrombolytic endovascular procedures

Safety and efficacy of mechanical aspiration thrombectomy for patients with acute lower extremity ischemia

OBJECTIVE

Acute limb ischemia (ALI) is associated with high rates of amputation and consequent morbidity and mortality. The objective of this study is to report on the safety and efficacy of aspiration thrombectomy using the Indigo Aspiration System in patients with lower extremity (LE) ALI.

METHODS

The STRIDE study was an international, multicenter, prospective, study that enrolled 119 participants presenting with LE-ALI. Patients were treated firstline with mechanical thrombectomy using the Indigo Aspiration System, before stenting or angioplasty, or other therapies as determined by treating physician. The primary end point was target limb salvage at 30 days after the procedure. Secondary end points within 30 days included technical success, defined as core laboratory-adjudicated Thrombolysis in Myocardial Infarction (TIMI) 2/3 flow rate immediately after the procedure, changes in modified Society for Vascular Surgery runoff score, improvement of Rutherford classification compared with before the procedure, patency, rate of device-related serious adverse events, and major periprocedural bleeding. Secondary end points that will be evaluated at 12 months include target limb salvage and mortality.

RESULTS

Of the 119 participants enrolled at 16 sites, the mean age was 66.3 years (46.2% female). At baseline (n = 119), ischemic severity was classified as Rutherford I in 10.9%, Rutherford IIa in 54.6%, and Rutherford IIb in 34.5%. The mean target thrombus length was 125.7 ± 124.7 mm. Before the procedure, 93.0% (of patients 107/115) had no flow (TIMI 0) through the target lesion. The target limb salvage rate at 30 days was 98.2% (109/111). The rate of periprocedural major bleed was 4.2% (5/119) and device-related serious adverse events was 0.8% (1/119). Restoration of flow (TIMI 2/3) was achieved in 96.3% of patients (105/109) immediately after the procedure. The median improvement in the modified Society for Vascular Surgery runoff score (before vs after the procedure) was 6.0 (interquartile range, 0.0-11.0). Rutherford classifications also improved after discharge in 86.5% of patients (83/96), as compared with preprocedural scores. Patency at 30 days was achieved in 89.4% of patients (101/113).

CONCLUSIONS

In the STRIDE (A Study of Patients with Lower Extremity Acute Limb Ischemia to Remove Thrombus with the Indigo Aspiration System) study, aspiration thrombectomy with the Indigo System provided a safe and effective endovascular treatment for patients with LE-ALI, resulting in a high rate (98.2%) of successful limb salvage at 30 days, with few periprocedural complications.

Percutaneous Thrombectomy in Patients with Occlusions of the Aortoiliac Segment: A Case Series

OBJECTIVE

Thrombectomy of the aortoiliac segment remains a challenge for surgical and endovascular revision. This study aimed to evaluate the concept of percutaneous thrombectomy in patients with aortoiliac segment occlusions.

MATERIALS & METHODS

Eighteen patients with aortoiliac occlusion who underwent percutaneous thrombectomy were retrospectively identified using the local picture archive and divided into the stent-graft (N = 10) and native vessels (N  =  8) groups. The procedure was performed by placing a 12-24 French sheath adjacent to the distal end of the occluded vessel segment. The occlusion was passed with a balloon catheter which was retracted after inflation, to deliver the thrombus into the sheath. Technical success (reperfusion of the vessel and no residual thrombus/stenosis < 30%), complications and primary arterial patency were assessed. Follow-up included computed tomography angiography and evaluation of the clinical situation via telephone.

RESULTS

Technical success was achieved in 38% (7/18) of patients after percutaneous thrombectomy alone and in 100% after additional procedures. The most common complication was peripheral embolism (44%, 8/18), which was treated successfully in all cases and was linked to a mismatch between the sheath and target vessel of ≥ 1 mm (P < .01). There were no significant differences in the incidence of complications between the two groups. Primary patency was 72% (13/18) with no significant difference between groups (P  =  .94). Follow-up CT scans were available for 13/18 patients (72%), with a mean follow-up time of 270  ±  146 days. All patients were contacted via phone (follow-up time, 653  ±  264 days).

CONCLUSION

Percutaneous thrombectomy appears to be effective for revascularization of the aortoiliac segment, both in stent-grafts and in native vessels. The most common complication is peripheral embolism; however, the risk may be reduced by choosing an adequate sheath size.

Percutaneous Thrombectomy for the Treatment of Lower Extremity Deep Vein Thrombosis: Medium-Term Follow-up Results and Analysis of 112 Cases

Introduction

The aim of this study was to analyze percutaneous thrombectomy (PT) outcomes for the management of lower extremity deep vein thrombosis (DVT) with medium-term follow-up.

Methods

The study included charts of patients who underwent PT due to lower extremity DVT between August 2017 and March 2021. Patient characteristics and procedure outcomes were recorded in the electronic information system on the same day as the procedure. The procedures with complete removal of thrombus following PT without requiring additional procedure or additional thrombectomy apparatus were considered successful. Also, duration of follow-up was noted.

Results

In total, 112 patients were enrolled in the study. The femoropopliteal (40.2%) and iliofemoral (25.0%) veins were the most common sites with thrombus detected. The duration of PT procedure and fluoroscopy were 123.1 minutes and 21.9 minutes, respectively. Estimated blood loss was 255.1 milliliters. The hospital stay and intensive care unit stay following PT were 3.7 and 1.4 days, respectively. Major hemorrhage did not occur in any patient, but we encountered bradycardia in six (5.4%) patients, acute renal failure in one (0.9%) patient, hemoglobinuria in 11 (9.8%) patients, leg pain in 15 (13.4%) patients, and pulmonary embolism in 2 (1.8) patients, respectively. Success of the present study was 94.6% in the first month, and re-operation was required only in one patient. The mean follow-up period was 21.1 months with 90.2% venous patency rates.

Conclusion

The present study demonstrated that PT was an effective and reliable treatment modality with acceptable complication rates for the treatment of lower extremity DVT. Additionally, the efficacy of PT was proven by mid-term follow-up results.