Combined treatment (image-guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia: Clinical efficacy and outcomes.

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  • Additional Information
    • Source:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • Publication Information:
      Original Publication: San Francisco, CA : Public Library of Science
    • Subject Terms:
      Endovascular Procedures* ; Surgery, Computer-Assisted*/methods ; Thrombectomy*/methods; Ischemia/*etiology ; Ischemia/*therapy ; Lower Extremity/*blood supply; Aged ; Aged, 80 and over ; Angioplasty ; Female ; Humans ; Ischemia/diagnosis ; Ischemia/mortality ; Kaplan-Meier Estimate ; Lower Extremity/diagnostic imaging ; Lower Extremity/pathology ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome
    • Abstract:
      Objectives: To evaluate the effectiveness and safety of combined treatment (image guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia.
      Methods: From 2009 to 2017, 52 patients (44 men, eight women, mean 67.2 years) underwent combined treatment for acute thrombotic occlusion of lower extremity arteries. The patients presented with acute limb ischemia and we selectively perform combined treatment in the cases with challenging clinical considerations (e.g. various spectrum of thrombus, underlying atherosclerotic lesions). Combined treatment included cutdown of common femoral artery, thrombectomy using a Fogarty balloon catheter, balloon angioplasty, stenting, and catheter-introduced thrombus fragmentation and aspiration. Patients' medical records were retrospectively reviewed and follow-up data were collected. The technical and clinical success rates and limb salvage were assessed. The Kaplan-Meier method was used to analyze primary patency rates and overall survival rates. Univariate analyses were performed to determine the factors related to clinical outcomes.
      Results: Technical and clinical success rate was 90.4% and 80.8%, respectively. The mean follow-up duration was 26.5 ± 25.8 months. Primary patency was 91.4%, 86.1%, and 74.6% at six months, 1-, and 2-year, respectively. Limb salvage without amputation was 88.5% (46/52). The overall survival rates at six months, 1-, and 3-year were 82.6%, 80.2, and 56.9%, respectively. The 30-day mortality was 5.8% (3/52). Univariate analysis showed that percutaneous transluminal angioplasty (PTA) type (balloon versus stent) was related to clinical failure.
      Conclusions: Combined treatment can be effective and safe for ALI patients even under challenging clinical conditions.
      Competing Interests: The authors have declared that no competing interests exist.
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    • Publication Date:
      Date Created: 20191116 Date Completed: 20200323 Latest Revision: 20200323
    • Publication Date:
      20240829
    • Accession Number:
      PMC6857913
    • Accession Number:
      10.1371/journal.pone.0225136
    • Accession Number:
      31730625