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 and 2024 were reviewed. Primary outcomes were 30-day and 1-year freedom from major amputation. Secondary outcomes were mortality and major adverse cardiovascular events at 30 days, need for adjuvant thrombolysis, conversion to open surgery, and major bleeding events. Results: Seventy patients (73 limbs) with mean age 67 years (range, 32-105 years) had a median follow-up of 525 days (range, 0-2554 days). 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. Of the patients, 42.5% had adjuvant overnight catheter-directed thrombolysis, and 15.1% were converted to open surgery. Of the limbs, 91.8% required adjuvant procedures (61 angioplasty, 33 stenting, 11 prophylactic, and 4 delayed fasciotomies) during or after the index procedure. The device used was Penumbra Indigo, 61.6% (45/73 limbs); AngioJet, 32.9% (24/73 limbs); and both, 5.5% (4/73 limbs). Thirty-day and 1-year freedom from major amputation were 91.0% and 74.8%, respectively. Thirty-day complications were 8.2% mortality, 9.6% major adverse cardiovascular events, and 6.8% major bleeding. Conclusions: 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.