Aspiration Thrombectomy versus Conventional Catheter-Directed Thrombolysis as First-Line Treatment for Noniatrogenic Acute Lower Limb Ischemia

Kwok, Chi Ho Ricky; Fleming, Scott; Chan, Kitty; Tibballs, Jonathan; Samuelson, Shaun; Ferguson, John; Nadkarni, Sanjay; Hockley, Joseph A.; Jansen, Shirley

doi:10.1016/j.jvir.2017.11.030

Cited by 33 publications

(21 citation statements)

References 17 publications

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“…143,146 First line use of aspiration thrombectomy can reduce the need for CDT, without increasing costs. 141,147 3.6.2. Endovascular mechanical thrombectomy.…”

Section: Recommendation 32mentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Björck

Earnshaw

Acosta

et al. 2020

European Journal of Vascular and Endovascular Surgery

315

222

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“…143,146 First line use of aspiration thrombectomy can reduce the need for CDT, without increasing costs. 141,147 3.6.2. Endovascular mechanical thrombectomy.…”

Section: Recommendation 32mentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Björck

Earnshaw

Acosta

et al. 2020

European Journal of Vascular and Endovascular Surgery

315

222

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“…However, in many interventional institutions, this technique represents the treatment of choice in acute limb ischemia. In a retrospective study Kwok et al [42] compared thrombolysis with primary aspiration embolectomy. Technical success was achieved approximately in half of the cohort by primary aspiration alone.…”

Section: Catheter-directed Thrombolysis (Cdt)mentioning

confidence: 99%

“…Technical success was achieved approximately in half of the cohort by primary aspiration alone. PAT, if successful as a standalone treatment, obviates the requirement for CDT with a concomitant reduction in the risk of hemorrhagic complications [42]. Factors limiting widespread use are decreased effectiveness in cases of organized thrombus and in large vessels, less favorable results in patients with disseminated atherosclerotic lesions and the risk of inadvertent vessel injury if multiple catheter passages are required unless a long sheath with a removable hemostatic valve is placed close to the occlusion [29].…”

Section: Catheter-directed Thrombolysis (Cdt)mentioning

confidence: 99%

Current Treatment Options in Acute Limb Ischemia

Fluck

Augustin

Bley

et al. 2019

Fortschr Röntgenstr

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Background Acute limb ischemia represents a clinical emergency with eventual limb loss and life-threatening consequences. It is characterized by a sudden decrease in limb perfusion. Acute ischemia is defined as a duration of symptoms for less than 14 days. Aging of the population increases the prevalence of acute limb ischemia. The two principal etiologies are arterial embolism and in situ thrombosis of an atherosclerotic artery. Immediate diagnosis, accurate assessment and urgent intervention when needed are crucial to save the limb and to prevent a major amputation. Delay in diagnosis and therapy may lead to irreversible ischemic damage. Method To assess the current treatment options in acute limb ischemia, this review is based on a selective literature search in PubMed representing the current state of research. Results and Conclusion Patients with acute limb ischemia should receive immediate anticoagulation. Treatment depends on the classification based on the degree of ischemia and limb viability. Especially acute (< 14 days symptom duration) Rutherford Categories IIa and IIb with marginally and immediately threatened limbs require definitive therapeutic intervention and are salvageable, if promptly revascularized. The current literature suggests that open surgical revascularization is more time effective then catheter-directed thrombolysis. However, with the advent of thrombolytic delivery systems and mechanical thrombectomy devices, treatment time can be minimized and successful utilization in patients with Category IIb (Rutherford Classification for Acute Limb Ischemia) has been reported with promising limb-salvage and survival rates. Large randomized studies are still missing, and guidelines suggest choosing the method of revascularization depending on anatomic location, etiology, and local practice patterns, with the time to restore the blood flow being an important factor to consider. Key points: Citation Format

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“…4,9,12 In addition to catheter-directed thrombolysis, endovascular thrombectomy may serve as a complimentary or standalone technique for percutaneous revascularization that ideally speeds revascularization and limits the need for thrombolysis. [19][20][21][22][23][24][25] Endovascular thrombectomy has seen rapid innovation and increase in the number of devices available over the past decades. The devices are often categorized into four groups: mechanical aspiration, rheolytic, ultrasonic, or combination.…”

Section: Endovascular Revascularizationmentioning

confidence: 99%

“…Embolization risk may be offset with protection devices and is advisable in high-risk patients with single vessel runoff. 2,9,19,22,26 It is important to recall that endovascular thrombolysis or thromboembolectomy, at best, restores the vasculature to its baseline condition and the remaining thrombogenic lesion must be addressed in an endovascular (angioplasty or stent placement), open surgical, or hybrid technique to achieve a durable result.…”

Section: Endovascular Revascularizationmentioning

confidence: 99%

Acute Limb Ischemia Therapies: When and How to Treat Endovascularly

Hage

McDevitt

Vadlamudi

2018

Semin intervent Radiol

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Acute limb ischemia is an emergent limb and life-threatening condition with high morbidity and mortality. An understanding of the presentation, clinical evaluation, and initial workup, including noninvasive imaging evaluation, is critical to determine an appropriate management strategy. Modern series have shown endovascular revascularization for acute limb ischemia to be safe and effective with success rates approaching surgical series and with similar, or even decreased, perioperative morbidity and mortality. A thorough understanding of endovascular techniques, associated pharmacology, and perioperative care is paramount to the endovascular management of patients presenting with acute limb ischemia. This article discusses the diagnosis and strategies for endovascular treatment of acute limb ischemia.

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Aspiration Thrombectomy versus Conventional Catheter-Directed Thrombolysis as First-Line Treatment for Noniatrogenic Acute Lower Limb Ischemia

Cited by 33 publications

References 17 publications

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Current Treatment Options in Acute Limb Ischemia

Acute Limb Ischemia Therapies: When and How to Treat Endovascularly

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