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


Autoři: Soo Buem Cho aff001;  Ho Cheol Choi aff002;  Sang Min Lee aff002;  Jae Boem Na aff002;  Mi Jung Park aff002;  Hwa Seon Shin aff002;  Jung Ho Won aff002;  Chung Eun Lee aff003;  Sung Eun Park aff004
Působiště autorů: Department of Radiology, Ewha Womans University Seoul Hospital, Ewha Womans University, College of Medicine, Seoul, Korea aff001;  Department of Radiology, Gyeongsang National University School of Medicine and Gyeonsang National University Hospital, Jinju, Korea aff002;  Thoracic and Cardiovascular Surgery, Gyeongsang National University School of Medicine and Gyeonsang National University Hospital, Jinju, Korea aff003;  Department of Radiology, Gyeongsang National University School of Medicine and Gyeonsang National University Changwon Hospital, Changwon, Korea aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225136

Souhrn

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.

Klíčová slova:

Arteries – Catheters – Ischemia – Lesions – Stent implantation – Thrombosis – Revascularization – Femoral arteries


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