Limb salvage using Pounce LP mechanical thrombectomy system after failed open and percutaneous thromboembolectomy

Mechanical thrombectomy devices have limited efficacy in organized subacute and chronic thrombi and face challenges in small-caliber distal vessels. The Pounce LP Thrombectomy System (Surmodics) is a fully percutaneous, purely mechanical thrombectomy device designed to overcome these limitations. We report the case of an 83-year-old female presenting to an out-of-state hospital with acute limb ischemia secondary to a right external iliac artery occlusion. Despite percutaneous mechanical thrombectomy with an aspiration thrombectomy device and subsequent open Fogarty balloon thromboembolectomy for distal embolization, her ischemia worsened, and a below-knee amputation was recommended. Upon transfer to our institution, she had sensorimotor deficits, distal ischemic changes, and occlusions of the anterior tibial, posterior tibial, and peroneal arteries at the level of the midcalf. Mechanical thrombectomy using the Pounce LP device successfully removed organized thrombus and restored multiphasic inline flow to the peroneal artery and its communicating branch, which subsequently fed into the distal posterior tibial artery and the plantar vessels. The patient ultimately underwent a successful transmetatarsal amputation, achieving limb salvage.