Outcomes of mechanical thrombectomy for acute limb ischemia at a tertiary referral center.

Abstract

Acute limb ischemia (ALI) harbors high risk of limb loss and mortality. We reviewed the use and outcomes of mechanical thrombectomy devices in the management of ALI at a tertiary referral center. ALI cases with duration of symptoms <2 weeks and treated with mechanical thrombectomy at a tertiary referral center between 2016 and 2024 were reviewed. Primary outcomes were 30-day and 1-year freedom from major amputation. Secondary outcomes were mortality and major adverse cardiovascular events at 30 days, need for adjuvant thrombolysis, conversion to open surgery, and major bleeding events. Seventy patients (73 limbs) with mean age 67 years (range, 32-105 years) had a median follow-up of 525 days (range, 0-2554 days). Rutherford Class was 1 (46.6%), 2a (30.1%), 2b (20.6%), 3 (0%), and unknown (2.7%). Etiology was thrombosis (56.5%) or embolism (30.4%) of native artery in 46 limbs, thrombosed bypass in 14 limbs, and thrombosed stents in 13 limbs. Of the patients, 42.5% had adjuvant overnight catheter-directed thrombolysis, and 15.1% were converted to open surgery. Of the limbs, 91.8% required adjuvant procedures (61 angioplasty, 33 stenting, 11 prophylactic, and 4 delayed fasciotomies) during or after the index procedure. The device used was Penumbra Indigo, 61.6% (45/73 limbs); AngioJet, 32.9% (24/73 limbs); and both, 5.5% (4/73 limbs). Thirty-day and 1-year freedom from major amputation were 91.0% and 74.8%, respectively. Thirty-day complications were 8.2% mortality, 9.6% major adverse cardiovascular events, and 6.8% major bleeding. Overall freedom from amputation after mechanical thrombectomy was 91.0% at 30 days, which is comparable with a recent multicenter trial, although with a higher rate of adjuvant thrombolysis and conversion to open thrombectomy in the current study. Mechanical thrombectomy is an effective treatment for ALI in "real-world" practice.