Journal of vascular and interventional radiology : JVIR · 2025
Direct Stent Placement versus Percutaneous Mechanical Thrombectomy in Selected Patients with Acute Lower Limb Ischemia: Short- and Long-Term Outcomes.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Galanakis Nikolaos, Vouidaski Angeliki, Kontopodis Nikolaos, Klontzas Michail E, Ioannou Christos V, Kehagias Elias
Аннотация
PURPOSE: To compare the safety and effectiveness of direct stent placement (DS) technique versus percutaneous mechanical thrombectomy (PMT) in patients with acute lower limb ischemia (ALI).
MATERIALS AND METHODS: This 10-year retrospective study included 50 selected patients of 465 patients who presented with ALI (Society for Vascular Surgery [SVS]/International Society for Cardiovascular Surgery [ISCVS] IIa, n = 24; SVS/ISCVS IIb, n = 26). The underlying causes included in situ thrombosis (n = 41) and embolism (n = 9). Patients were treated either with DS technique (n = 20) involving deployment of self-expanding stents across acute arterial occlusions or with PMT (n = 30) using AngioJet device.
RESULTS: Technical success was achieved in all cases. Access site adverse events (hematoma, dissection, and pseudoaneurysm) occurred in 2 patients in the DS group and 4 patients in the PMT group. No cases of reperfusion injury and 1 case of distal embolization in PMT group were reported. During follow-up, 2 minor and 2 major amputations were performed in the DS group and 3 major and 3 minor amputations in the PMT group. Primary patency rates for the DS and PMT group were 90% and 78.6% at 1 year, 84.7% and 74.2% at 2 years, and 69.3% and 69.6% at 3 years, respectively (P = .789). Amputation-free survival rates for the DS and PMT group were 85% and 86.7% at 1 year, 72.9% and 77.5% at 3 years, and 65% and 77.5% at 4 years, respectively (P = .635).
CONCLUSIONS: DS seems to be a safe and effective bailout treatment option for ALI, when PMT is unavailable, demonstrating comparable outcomes with PMT.
MATERIALS AND METHODS: This 10-year retrospective study included 50 selected patients of 465 patients who presented with ALI (Society for Vascular Surgery [SVS]/International Society for Cardiovascular Surgery [ISCVS] IIa, n = 24; SVS/ISCVS IIb, n = 26). The underlying causes included in situ thrombosis (n = 41) and embolism (n = 9). Patients were treated either with DS technique (n = 20) involving deployment of self-expanding stents across acute arterial occlusions or with PMT (n = 30) using AngioJet device.
RESULTS: Technical success was achieved in all cases. Access site adverse events (hematoma, dissection, and pseudoaneurysm) occurred in 2 patients in the DS group and 4 patients in the PMT group. No cases of reperfusion injury and 1 case of distal embolization in PMT group were reported. During follow-up, 2 minor and 2 major amputations were performed in the DS group and 3 major and 3 minor amputations in the PMT group. Primary patency rates for the DS and PMT group were 90% and 78.6% at 1 year, 84.7% and 74.2% at 2 years, and 69.3% and 69.6% at 3 years, respectively (P = .789). Amputation-free survival rates for the DS and PMT group were 85% and 86.7% at 1 year, 72.9% and 77.5% at 3 years, and 65% and 77.5% at 4 years, respectively (P = .635).
CONCLUSIONS: DS seems to be a safe and effective bailout treatment option for ALI, when PMT is unavailable, demonstrating comparable outcomes with PMT.