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Comparison of Low-Dose Catheter-Directed Thrombolysis with and without Pharmacomechanical Thrombectomy for Acute

Sagar S Gandhi1, Joseph A Ewing2, Emily Cooper2

  • 1Department of Surgery, Division of Vascular Surgery and Vascular Medicine, Greenville Health System, Greenville, SC; University of South Carolina School of Medicine Greenville, Greenville, SC.

Annals of Vascular Surgery
|July 26, 2017
PubMed

Insights

Catheter-directed thrombolysis (CDT) with or without pharmacomechanical thrombectomy (PMT) showed similar outcomes for acute lower extremity ischemia (ALI). Initial thrombus extraction using PMT did not significantly alter the need, duration, or efficacy of adjunctive CDT.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Thrombosis Management

Background:

  • Acute lower extremity ischemia (ALI) is a critical condition requiring prompt treatment.
  • Catheter-directed thrombolysis (CDT) and pharmacomechanical thrombectomy (PMT) are established methods for thrombus removal.
  • The role of PMT as an adjunct to CDT in ALI treatment warrants further investigation.

Purpose of the Study:

  • To compare the efficacy and safety of CDT with and without PMT for ALI treatment.
  • To evaluate whether initial PMT reduces the need or duration of adjunctive CDT.
  • To analyze outcomes including complications, patency, reintervention, and limb salvage.

Main Methods:

  • Retrospective review of 99 patients with ALI treated between 2008 and 2014.
  • Patients divided into two cohorts: PMT + CDT (n=54) and CDT alone (n=29).
  • Data collected on patient/limb characteristics, treatment duration, complications, and clinical outcomes.

Main Results:

  • No significant differences in patient characteristics, occlusion details, or ischemia duration between groups.
  • Similar outcomes observed for periprocedural complications, patency, reintervention, limb salvage, and amputation-free survival.
  • Mean lysis time and treatment duration were comparable across both treatment strategies.

Conclusions:

  • Pharmacomechanical thrombectomy (PMT) combined with catheter-directed thrombolysis (CDT) offers no significant advantage over CDT alone for acute lower extremity ischemia.
  • Initial thrombus extraction with PMT does not appear to reduce the overall need, duration, or effectiveness of CDT.
  • Both treatment strategies demonstrate comparable safety and efficacy in managing ALI.
Abstract

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