AI Article Synopsis
- The study analyzes the effectiveness of two methods of open surgical thromboembolectomy (TE) for treating acute lower limb ischemia (ALLI) over a 10-year period, comparing fluoroscopic assisted TE (FATE) to blind and selective on-demand fluoroscopic-assisted TE (BSTE).
- A total of 108 patients were treated, revealing a 30-day mortality rate of 12.0% and a major amputation rate of 6.5%, with no significant differences between the two methods in these outcomes.
- The FATE method showed advantages like the use of local anesthesia and fewer required further interventions, indicating it might provide a more effective and less invasive approach to managing ALLI.
Article Abstract
Objectives: The current treatment of acute lower limb ischemia (ALLI) includes open surgical and percutaneous pharmaco-mechanical thromboembolectomy (TE). We hereby report our results with open surgical TE over a 10-year period and compare our outcomes using routine fluoroscopic assisted TE (FATE) with blind and selective on demand fluoroscopic-assisted TE (BSTE).
Methods: This is a retrospective analysis of all patients who underwent open surgical TE for acute lower limb ischemia at a single tertiary center between 2008 and 2018. Patients were divided into a group who underwent BSTE and another who underwent routine FATE. Data on presentation, medical history, surgery performed, and short-term outcomes were retrieved from medical record. Comparison between baseline characteristics and outcomes of both groups were made using t-test and chi-square analysis.
Results: Over 10 years, 108 patients underwent surgical TE. Thirty-day mortality rate and 30-day major lower extremity amputation rate in the cohort were 12.0% and 6.5%, respectively. On subgroup analysis, 53 patients were treated by BSTE and 55 patients by FATE. There was no significant difference in 30-day mortality rate (11.3% vs 12.7%, -value = .82) and 30-day major amputation rate (9.4% vs 3.6%, -value = .454) between the two groups. Local anesthesia was more frequently performed in patients undergoing FATE (58.2% vs 24.5%, -value < .001). More than one arteriotomy was more frequently required in patients undergoing BSTE (2.6% vs 45.5%, -value < .001). Patients with infrapopliteal involvement undergoing FATE required less further interventions such as patch angioplasty (2.6% vs 36.4%, -value < .001) and bypass (2.6% vs 22.7%, -value = .01).
Conclusion: ALLI remains a disease of high morbidity and mortality. Open surgical TE offers an effective approach to treat ALLI. The addition of fluoroscopy to the conduction of TE could be associated with valuable benefits, especially in patients with infra-popliteal involvement. Randomized controlled trials are needed to objectively assess the therapeutic potential of FATE.
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| http://dx.doi.org/10.1177/17085381221075478 | DOI Listing |
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