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



To evaluate the effectiveness and safety of combined treatment (image guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia.


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.


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.


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


1. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: Revised version. Journal of Vascular Surgery. 1997; 26: 517–538. doi: 10.1016/s0741-5214(97)70045-4 9308598

2. Kashyap VS, Gilani R, Bena JF, Bannazadeh M, Sarac TP. Endovascular therapy for acute limb ischemia. J Vasc Surg. 2011; 53: 340–346. doi: 10.1016/j.jvs.2010.08.064 21050699

3. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Journal of Vascular Surgery. 2007; 45: S5–S67. doi: 10.1016/j.jvs.2006.12.037 17223489

4. Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg. 2009; 22: 5–9. doi: 10.1053/j.semvascsurg.2008.12.003 19298929

5. Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial. Ann Surg. 1994; 220: 251–266; discussion 266–258. doi: 10.1097/00000658-199409000-00003 8092895

6. Ouriel K, Veith FJ, Sasahara AA. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med. 1998; 338: 1105–1111. doi: 10.1056/NEJM199804163381603 9545358

7. Parsons RE, Marin ML, Veith FJ, Sanchez LA, Lyon RT, Suggs WD, et al. Fluoroscopically assisted thromboembolectomy: an improved method for treating acute arterial occlusions. Ann Vasc Surg. 1996; 10: 201–210. doi: 10.1007/BF02001883 8792986

8. de Donato G, Setacci F, Sirignano P, Galzerano G, Massaroni R, Setacci C. The combination of surgical embolectomy and endovascular techniques may improve outcomes of patients with acute lower limb ischemia. J Vasc Surg. 2014; 59: 729–736. doi: 10.1016/j.jvs.2013.09.016 24342067

9. Fogarty TJ, Chin AK, Olcott Ct, Shoor PM, Zimmerman JJ, Garry MT. Combined thrombectomy and dilation for the treatment of acute lower extremity arterial thrombosis. J Vasc Surg. 1989; 10: 530–533; discussion 533–534. doi: 10.1067/mva.1989.15454 2810538

10. Cardella JF, Kundu S, Miller DL, Millward SF, Sacks D. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2009; 20: S189–191. doi: 10.1016/j.jvir.2009.04.035 19559998

11. Vedantham S, Sista AK, Klein SJ, Nayak L, Razavi MK, Kalva SP, et al. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2014; 25: 1317–1325. doi: 10.1016/j.jvir.2014.04.019 25000825

12. Ouriel K, Shortell CK, DeWeese JA, Green RM, Francis CW, Azodo MV, et al. A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia. J Vasc Surg. 1994; 19: 1021–1030. doi: 10.1016/s0741-5214(94)70214-4 8201703

13. Ouriel K, Veith FJ, Sasahara AA. Thrombolysis or peripheral arterial surgery: phase I results. TOPAS Investigators. J Vasc Surg. 1996; 23: 64–73; discussion 74–65. doi: 10.1016/s0741-5214(05)80036-9 8558744

14. Weaver FA, Comerota AJ, Youngblood M, Froehlich J, Hosking JD, Papanicolaou G. Surgical revascularization versus thrombolysis for nonembolic lower extremity native artery occlusions: results of a prospective randomized trial. The STILE Investigators. Surgery versus Thrombolysis for Ischemia of the Lower Extremity. J Vasc Surg. 1996; 24: 513–521; discussion 521–513. doi: 10.1016/s0741-5214(96)70067-8 8911400

15. Plecha FR, Pories WJ. Intraoperative angiography in the immediate assessment of arterial reconstruction. Arch Surg. 1972; 105: 902–907. doi: 10.1001/archsurg.1972.04180120081015 4639787

16. Davies MG, Saad WE, Peden EK, Mohiuddin IT, Naoum JJ, Lumsden AB. Impact of runoff on superficial femoral artery endoluminal interventions for rest pain and tissue loss. J Vasc Surg. 2008; 48: 619–625; discussion 625–616. doi: 10.1016/j.jvs.2008.04.013 18727964

17. Yeager RA, Moneta GL, Taylor LM Jr., Hamre DW, McConnell DB, Porter JM. Surgical management of severe acute lower extremity ischemia. J Vasc Surg. 1992; 15: 385–391; discussion 392–383. doi: 10.1067/mva.1992.33848 1735899

18. Kuukasjarvi P, Salenius JP. Perioperative outcome of acute lower limb ischaemia on the basis of the national vascular registry. The Finnvasc Study Group. Eur J Vasc Surg. 1994; 8: 578–583. doi: 10.1016/s0950-821x(05)80594-8 7813724

19. Campbell WB, Ridler BM, Szymanska TH. Current management of acute leg ischaemia: results of an audit by the Vascular Surgical Society of Great Britain and Ireland. Br J Surg. 1998; 85: 1498–1503. 9823910

20. Taha AG, Byrne RM, Avgerinos ED, Marone LK, Makaroun MS, Chaer RA. Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia. J Vasc Surg. 2015; 61: 147–154. doi: 10.1016/j.jvs.2014.06.109 25080883

21. Bosch JL, Hunink MG. Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease. Radiology. 1997; 204: 87–96. doi: 10.1148/radiology.204.1.9205227 9205227

22. Goode SD, Cleveland TJ, Gaines PA. Randomized clinical trial of stents versus angioplasty for the treatment of iliac artery occlusions (STAG trial). Br J Surg. 2013; 100: 1148–1153. doi: 10.1002/bjs.9197 23842828

23. Chowdhury MM, McLain AD, Twine CP. Angioplasty versus bare metal stenting for superficial femoral artery lesions. Cochrane Database Syst Rev. 2014: Cd006767. doi: 10.1002/14651858.CD006767.pub3 24959692

24. Rastan A, Krankenberg H, Baumgartner I, Blessing E, Muller-Hulsbeck S, Pilger E, et al. Stent placement versus balloon angioplasty for the treatment of obstructive lesions of the popliteal artery: a prospective, multicenter, randomized trial. Circulation. 2013; 127: 2535–2541. doi: 10.1161/CIRCULATIONAHA.113.001849 23694965

25. Fusaro M, Cassese S, Ndrepepa G, Tepe G, King L, Ott I, et al. Drug-eluting stents for revascularization of infrapopliteal arteries: updated meta-analysis of randomized trials. JACC Cardiovasc Interv. 2013; 6: 1284–1293. doi: 10.1016/j.jcin.2013.08.007 24355118

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