Clot Composition Analysis in Peripheral Arterial Disease: A Systematic Review

Peripheral arterial thromboembolic disease is a key cause of limb-threatening ischemia. Clot composition analysis may offer insights into thrombus etiology and aid in treatment decisions. This review aims to synthesize the current available literature on the histopathological evaluation of thrombi retrieved from peripheral arterial interventions for acute limb-threatening events. The objective of this study is to systematically review the current evidence on histopathological and qualitative analysis of thrombi retrieved during peripheral arterial interventions for acute limb-threatening ischemic events and to evaluate whether clot composition has demonstrated diagnostic or therapeutic impact. A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered with PROSPERO (CRD420251016001). The major databases PubMed, Embase, and Cochrane CENTRAL were searched. Studies involving histological and/or qualitative analysis of clots ("thrombi") retrieved from patients with peripheral arterial thromboembolic events were included. A total of 1,943 records were identified. Ultimately, five studies met the inclusion criteria and were analyzed qualitatively. Studies demonstrated limited but varied histopathological approaches including mass spectrometry, scanning electron microscopy, and biochemical assays. No consistent diagnostic or treatment impact was identified. Data were limited and prevented quantitative analysis. There is a significant lack of data on histopathological analysis of thrombi retrieved during peripheral arterial thromboembolectomy. Despite promising developments in cardiac and neurovascular fields, current evidence does not support routine clot composition analysis in peripheral vascular surgery. Further research is needed to define its translational role and value to the domain of vascular surgery.