Outcome of Percutaneous Mechanical Thrombectomy Compare with Catheter Directed Thrombolysis in Acute and Subacute Lower Limb Ischemia Patients
Puangpunngam N, MD1, Pleehachinda P, MD1, Ruangsetakit C, MD1, Wongwanit C, MD1, Sermsathanasawadi N, MD, PhD1, Chinsakchai K, MD1, Hahtapornsawan S, MD1, Hongku K, MD1, Mutirangura P, MD1
Affiliation : 1 Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Catheter based therapy is standard treatment for acute and subacute lower limb ischemia with Rutherford class IIa
and IIb. Besides Catheter directed thrombolysis (CDT), Percutaneous mechanical thrombectomy (PMT) is a novel treatment that
can remove thrombus faster with less complication. However, no previous study that compare the treatment outcome between
PMT and CDT.
Objective : To compare the treatment outcomes between PMT and CDT. Primary outcome is limb salvage rate. Complication, operative
time, number of operations, time to lysis, complete clot removal, technical success, length of intensive care unit (ICU) stay and
hospital stay were recorded as secondary outcomes.
Materials and Methods : Retrospective chart review of acute and subacute lower limb ischemic patient with severity Rutherford
class IIa and IIb from November 2014 to April 2017. We included all of patient treated with PMT and 22 patients treated with CDT
based on the similarity of level and severity into our study. This ratio was 1: 2 in line with head-to-head comparison method to
empower the result.
Result: Thirty-four patient were enrolled in the present study. 12 patients were allocated to PMT group and 22 patients were
allocated to CDT group. There was no significant difference between in demographic data and severity of ischemia, except we found
more thrombosis etiology in PMT group (72.7% vs. 33.33%, p = 0.04). Limb salvage at perioperative period (0% vs. 4.8%, p = 0.656)
and at 3-month (80% vs. 80%, p = 0.751) were comparable between two groups. There are more technical success rate (100% vs.
85.7%, p = 0.268) and complete clot removal (87.1% vs. 57.1%, p = 0.2) in PMT group without statistical significance. Only one
patient in PMT group need adjunctive CDT resulting in PMT group need less dose of rt-PA (0 vs. 30 mg, p = 0.001) and less number
of operation (1 vs. 3 times, p = 0.002). Only minor bleeding was found in 2 PMT patients. On the other hand, we found 5 patients had
minor bleeding and 1 patient had major bleeding in CDT group.
Conclusion : In the present study, we found comparable limb salvage rate between PMT and CDT group. Furthermore, PMT had
benefits of reducing the need of thrombolysis, operative time and bleeding complication.
Keywords : Acute limb ischemia, Mechanical thrombectomy, Thrombolysis
