Limb salvage rates in Acute Limb Ischemia patients treated with Open thrombectomy vs Catheter Directed Thrombolysis from an Acute Care Vascular Center in the Southern region of Puerto Rico
Jose Luis Ortiz-Fullana
St. Luke's Episcopal Medical Center, Ponce, Puerto Rico
Limb salvage rates in Acute Limb Ischemia patients treated with Open thrombectomy vs. Catheter-Directed Thrombolysis from an Acute Care Vascular Center in the Southern region of Puerto RicoJosé Ortiz-Fullana, MD, MPH; Patricia Mulero Soto, MD; Camille A. Ruiz-Arroyo, MD; Nichole M. Viera Rodríguez, MD; Ian Cummings Ruiz, MDc; Rafael Santini-Dominguez, MD FACS; Jorge Martinez-Trabal, MD FACSDivision of Vascular Surgery, Department of General Surgery at St. Luke’s Episcopal Medical Center, Ponce Health Sciences University, Ponce, Puerto Rico
Intro:
Our institution is the first specialized center in acute vascular pathologies in Puerto Rico. Acute limb ischemia is a time-sensitive vascular pathology which requires prompt recognition and management. Catheter-directed thrombolysis and open thrombectomy are indicated depending on clinical presentation. Our main objective is to evaluate peri-amputation rates of patients with acute limb ischemia treated with either modality.
Methods:
A retrospective cohort study was conducted of all the patients that arrived in our institution with the diagnosis of acute limb ischemia (ALI) from 2017 to 2021. Using the electronic medical record (EMR) we identified the severity of presentation, comorbidities, procedure performed, complications such as amputations and hemorrhagic shock. The Inclusion criteria were: patients more than 21 year-old and diagnosis of acute limb ischemia with Rutherford classification of 1, 2A and 2B.
Results:
We received a total of 118 patients with the diagnosis of ALI from 2017 through 2021. Most commonly patients presented with a Rutherford 2A acute limb ischemia however, a greater proportion were treated with open thrombectomy (68%). Thrombectomy had higher amputation rate (17.2%) vs. catheter-directed thrombolysis (13.5%). Kaplan-Meir analysis revealed better 30-day peri-operative amputation free survival in patients undergoing catheter-directed thrombolysis vs. open thrombectomy. On the other hand, long term amputation-free survival was similar between both treatment modalities.
Conclusion:
Patients with clear indications for catheter-directed thrombolysis have a higher peri-operative amputation-free survival when compared to open thrombectomy. Moreover, higher number of thrombectomy procedures likely are due to acute-on-chronic presentation in patients not amenable to revascularization. More importantly, timeline of symptoms is as important as clinical scenario when choosing treatment modality.
Figure 1. Kaplan-Meier chart representing limb salvage between patients who underwent catheter-directed thrombolysis vs. open thrombectomy.
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