Gary M Ansel1, Charles F Botti1, Mitchell J Silver1. 1. Midwest Cardiology Research Foundation, Mid-Ohio Cardiology Consultants, Inc., 3545 Olentangy River Road, Suite 325, Columbus, Ohio.
Abstract
OBJECTIVES: The study evaluated long-term limb salvage and survival of an endovascular approach that incorporates mechanical thrombectomy (PMT) in the management of arterial thrombosis. BACKGROUND: Acute limb ischemia is associated with a high risk of amputation and death. Previous reports from the United States (U.S.) of surgical and nonsurgical treatments are limited to primarily 30 days to 1 year. METHODS: Single-center, retrospective review of 57 consecutive patients (30 male, 27 female; mean age 63.8 +/- 13.8 years) treated for limb threatening ischemia due to thrombotic arterial occlusions. Data includes baseline assessments, procedural outcomes, in-hospital complications, 30-day, and long-term follow-up. RESULTS: Ninety-three percent of patients (n = 53) presented with onset of symptoms (<14 days). Angiography following PMT showed thrombus removal complete/substantial 36 (63.6%), partial 16 (28.0%), and minimal 5 (8.8%), respectively. Catheter-directed thrombolysis was used after PMT in 18 patients (31.6%). In-hospital success with limb salvage was attained in 96.5% (n = 55) with mortality of 3.5% (n = 2). Thirty-day limb salvage and mortality were 94.7% (n = 54) and 5.3% (n = 3), respectively. At mean 5-year follow-up (mean = 62 months), three patients have been lost to follow-up. The results of 54/57 (94.7%) are available. Amputation free survival was 94.7% (n = 36/38) with long-term mortality rate of 29.6% (n = 16/54). CONCLUSIONS: Acute limb ischemia treated with PMT alone or in combination with thrombolysis, followed by definitive therapy, results in favorable long-term limb salvage. Allowing for appreciable long-term mortality in vascular patients, survivors demonstrate amputation-free success from the initial endovascular procedure with low reintervention rate. Copyright 2008 Wiley-Liss, Inc.
OBJECTIVES: The study evaluated long-term limb salvage and survival of an endovascular approach that incorporates mechanical thrombectomy (PMT) in the management of arterial thrombosis. BACKGROUND:Acute limb ischemia is associated with a high risk of amputation and death. Previous reports from the United States (U.S.) of surgical and nonsurgical treatments are limited to primarily 30 days to 1 year. METHODS: Single-center, retrospective review of 57 consecutive patients (30 male, 27 female; mean age 63.8 +/- 13.8 years) treated for limb threatening ischemia due to thrombotic arterial occlusions. Data includes baseline assessments, procedural outcomes, in-hospital complications, 30-day, and long-term follow-up. RESULTS: Ninety-three percent of patients (n = 53) presented with onset of symptoms (<14 days). Angiography following PMT showed thrombus removal complete/substantial 36 (63.6%), partial 16 (28.0%), and minimal 5 (8.8%), respectively. Catheter-directed thrombolysis was used after PMT in 18 patients (31.6%). In-hospital success with limb salvage was attained in 96.5% (n = 55) with mortality of 3.5% (n = 2). Thirty-day limb salvage and mortality were 94.7% (n = 54) and 5.3% (n = 3), respectively. At mean 5-year follow-up (mean = 62 months), three patients have been lost to follow-up. The results of 54/57 (94.7%) are available. Amputation free survival was 94.7% (n = 36/38) with long-term mortality rate of 29.6% (n = 16/54). CONCLUSIONS:Acute limb ischemia treated with PMT alone or in combination with thrombolysis, followed by definitive therapy, results in favorable long-term limb salvage. Allowing for appreciable long-term mortality in vascular patients, survivors demonstrate amputation-free success from the initial endovascular procedure with low reintervention rate. Copyright 2008 Wiley-Liss, Inc.
Authors: Marie D Gerhard-Herman; Heather L Gornik; Coletta Barrett; Neal R Barshes; Matthew A Corriere; Douglas E Drachman; Lee A Fleisher; Francis Gerry R Fowkes; Naomi M Hamburg; Scott Kinlay; Robert Lookstein; Sanjay Misra; Leila Mureebe; Jeffrey W Olin; Rajan A G Patel; Judith G Regensteiner; Andres Schanzer; Mehdi H Shishehbor; Kerry J Stewart; Diane Treat-Jacobson; M Eileen Walsh Journal: Circulation Date: 2016-11-13 Impact factor: 29.690
Authors: Marie D Gerhard-Herman; Heather L Gornik; Coletta Barrett; Neal R Barshes; Matthew A Corriere; Douglas E Drachman; Lee A Fleisher; Francis Gerry R Fowkes; Naomi M Hamburg; Scott Kinlay; Robert Lookstein; Sanjay Misra; Leila Mureebe; Jeffrey W Olin; Rajan A G Patel; Judith G Regensteiner; Andres Schanzer; Mehdi H Shishehbor; Kerry J Stewart; Diane Treat-Jacobson; M Eileen Walsh Journal: Circulation Date: 2016-11-13 Impact factor: 29.690