Endovascular therapy for acute limb ischemia.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Acute limb ischemia (ALI) of the lower extremities presents a significant clinical challenge.
• Endovascular therapies are increasingly utilized for ALI treatment.
• This study evaluates outcomes of intra-arterial thrombolysis and adjuvant endovascular techniques for ALI.

Purpose of the Study:

• To assess the effectiveness and outcomes of endovascular intra-arterial thrombolysis for acute lower extremity ALI.
• To compare success rates, thrombolysis duration, and 30-day outcomes.
• To analyze long-term patency, limb salvage, and survival rates.

Main Methods:

• Retrospective review of consecutive ALI patients treated with endovascular methods (2005-2007).
• Statistical analysis using generalized estimating equations and time-to-event methods (Kaplan-Meier, Cox models).
• Evaluation of technical success, 30-day outcomes, mortality, patency, limb salvage, and survival.

Main Results:

• Technical success achieved in 82% of 129 limbs (119 patients).
• 30-day mortality was 6.0%, exclusively in females (P=.002).
• 24-month primary patency was 37.7%, secondary patency 65.3%. Limb salvage at 24 months was 68.8%. Female gender and thrombolysis ≥3 days increased limb loss risk. Women had decreased survival rates (HR 6.29).

Conclusions:

• Endovascular therapy with thrombolysis is an effective treatment for lower extremity ALI.
• Limiting thrombolysis duration to less than three days is recommended.
• Female gender is associated with poorer limb salvage and survival rates.