Outcomes of Mechanical Thrombectomy for Acute Limb Ischemia at a Tertiary Referral Center.

Abstract

Objective: 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.

Methods: ALI cases with duration of symptoms <2 weeks and treated with mechanical thrombectomy at a tertiary referral center between 2016-2024 were reviewed. Primary outcomes were 30-day and 1-year freedom from major amputation. Secondary outcomes were mortality and major adverse cardiovascular event (MACE) at 30 days, need for adjuvant thrombolysis, conversion to open surgery, and major bleeding events.

Results: 70 patients (73 limbs) with mean age 67 years (range 32-105 years) had a median follow-up of 525 days [0-2554]. 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. 42.5% had adjuvant overnight catheter-directed thrombolysis and 15.1% were converted to open surgery. 91.8% of limbs required adjuvant procedures (61 angioplasty, 33 stenting, 11 prophylactic and 4 delayed fasciotomies) during or after the index procedure. Device used was Penumbra Indigo® 61.6% (45/73 limbs), AngioJet^TM 32.9% (24/73), and both 5.5% (4/73). 30-day and 1-year freedom from major amputation was 91.0% and 74.8%, respectively. 30-day complications were 8.2% mortality, 9.6% MACE, and 6.8% major bleeding.

Conclusion: 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.