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Home > Vascular Annual Meeting^® > PP37. Contemporary Results with Endovascular Therapy...

PP37. Contemporary Results with Endovascular Therapy for Acute Limb Ischemia

Ramyar Gilani, Mohsen Bannazadeh, James F. Bena, Timur P. Sarac, Vikram S. Kashyap
The Cleveland Clinic Foundation, Cleveland, OH

OBJECTIVES: Endovascular therapies play an increasing role in the treatment of acute limb ischemia. The purpose of this study was to assess outcomes in patients treated for acute limb ischemia (ALI) with intra-arterial thrombolysis and/or percutaneous mechanical thrombectomy (PMT).

METHODS: Consecutive patients (n= 76) with ALI of the lower extremities treated via intra-arterial methods between January 1, 2005 and December 31, 2006 were identified and reviewed. Overall estimates of patency, limb salvage, and survival at 1 and 2 years were made using Kaplan-Meier estimation. Hazard ratios from Cox proportional hazards models were used to estimate differences in risk between groups for patency and survival.

RESULTS: Patients with ALI (82 limbs) presenting with native artery or graft thrombosis (76%) underwent thrombolysis and PMT (46%) under local anesthesia (96%) for an average of 1.6 days. Adjunctive procedures were required in 94% of patients to treat the culprit lesion with solely open revascularization in 16%. One patient had a major bleeding episode, but there was no intracranial hemorrhage in this cohort. 30-day amputation and mortality rates were 14% and 6%. Primary patency at 1 and 2 years were 52.1% (95% CI, 39.3- 64.8), and 41.6% (95% CI, 27.9-55.4), while secondary patency rates at 1 and 2 years were 74.6% (95% CI, 63.7-85.5), and 67.5% (95% CI, 55.1-80.0) respectively (median follow up=22.5 months). Limb salvage at 1 and 2 years was 86.5% (95% CI, 77.7-95.3) and 81.9% (95% CI, 71.5-92.3). Patients on dialysis (HR, 3.82; 95% CI, 2.22-6.59; p<0.001) and elevated creatinine levels (HR 1.16; 95% CI, 1.05- 1.29; p=0.004) were associated with primary patency loss. Overall survival at 1 and 2 years was 83.4% (95% CI, 74.4- 92.4) and 81.6% (95% CI, 72.1-91.1). Women were at an increased risk for mortality (HR, 16.93; 95% CI, 2.18-131.58; p=0.007) while those with COPD (HR, 3.12; 95% CI, 0.93-0.45; p=0.065) trended towards increased risk.

CONCLUSIONS: ALI remains a challenging clinical entity. Endovascular therapy is a safe and durable treatment option for patients presenting with lower extremity ALI. Patients with impaired renal function are associated with worse long term patency outcomes. Female patients are associated with decreased overall survival.

AUTHOR DISCLOSURES: R. Gilani, None; M. Bannazadeh, None; J.F. Bena, None; T.P. Sarac, None; V.S. Kashyap, None.