Early results of endovascular treatment using percutaneous vacuum-assisted thromboaspiration in acute lower limb ischemia

Abstract

Introduction. Open balloon thrombectomy and embolectomy remain the preferred initial option in the management of acute lower limb ischemia (ALI), but various endovascular techniques have become accessible and are growing in popularity. The aim of the study was to assess our early experience with percutaneous vacuum-assisted thromboaspiration using the Penumbra/Indigo® system for non-traumatic ALI. Material and methods. The study group comprised 13 patients with ALI who received treatment between September 2022 and June 2023; with 7 (53.8%) being males. The median age was 71 years (25%-75%IQR 62.5-77.5). ALI cases were classified according to the Rutherford scale: grade I – 2 (15.3%), grade IIA – 7 (53.8%), and grade IIB – 4 (30.7%). In 10 (76.9%) cases, ischemia was classified as “acute-on-chronic.” The occluded native vascular segment, determined through preoperative computer tomography angiography (n=4; 30.7%), duplex scanning (n=5; 38.4%), or both examinations (n=4; 30.7%), were as follows: superficial femoral artery (n=7) and popliteal artery (n=2). In two patients, thrombosis of the below-knee femoropopliteal bypass with autogenous vein was identified, while two others presented with femoral artery stent thrombosis. An embolic etiology of ALI was observed in 4 (30.7%) cases, and thrombotic etiology in 9 (69.2%) cases. Endovascular access was established via the ipsilateral common femoral artery (n=10), crossover (n=2), or brachial artery (n=1). Thromboaspiration was carried out using dedicated CAT6™ and CAT8™ catheters. Results. The technical success rate of vacuum-assisted thromboaspiration was 92.3%. Subsequent angiography revealed accompanying occlusive-stenotic lesions in all instances, necessitating transluminal angioplasty, and in 8 (61.5%) patients, additional stenting was required. Catheter-directed thrombolysis was utilized as an adjunct in one patient. There were 2 (15.3%) instances of distal embolization, both addressed within the same surgical session. Survival and limb salvage rates at the 30th-day follow-up stood at 100%. Conclusions. Utilizing the Penumbra/Indigo® system, percutaneous vacuum-assisted thromboaspiration appears to be a safe and effective minimally invasive technique for treating ALI. This method allows for the concurrent correction of coexisting chronic peripheral arterial lesions.