Acute limb ischemia (ALI) is a vascular emergency with high mortality rate. It has been defined as a sudden occlusion of limb perfusion compromising its viability. It is most frequently caused by an embolism followed by in situ thrombosis. Even though ALI incidence has recently declined, it is still high, affecting close to 1.5 patients every 10,000 persons.
This condition has been associated to higher risk of major cardiac events, amputation and death driving the advance of revascularization techniques, which increased endovascular revascularization cases over 100% of since 2003 until 2011. The evidence suggests endovascular revascularization presents lower complications rates without increased amputation risk vs. surgical revascularization.
Study Objective
The study aimed at assessing ALI endovascular revascularization outcomes using a multicenter registry, in addition to identifying mortality and amputation risk factors after endovascular revascularization.
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End Points
Primary end point was a combined event of death and unplanned amputation during hospitalization while secondary end point was comprised of the individual primary end point components.
Results
3,541 patients were included, mean age 66, mostly men. There were 132 deaths (3.7%) and 77 amputations (2.2%) during hospitalization. Thrombolysis catheters were used in 27.7% (n = 981) of cases and mechanical thrombectomy catheters in 3.9% (n = 138) of cases. Independent predictors of death or amputation were severe lung disease (OR: 1.72; DI 95%: 1.17-2.52), Rutherford class IIb (OR: 2.44; CI 95%: 1.62-3.65), terminal kidney disease (OR: 3.94; IC 95%: 0.73-0.85) and pre-procedural hemoglobin levels (OR: 0.78; CI 95%: 0.73-0.85). Main complications were bleeding within the first 72 hrs. after intervention (6.7%) and thrombosis (2.8%).
Conclusión
This study on ALI endovascular revascularization offers valuable information on factors influencing adverse results in these patients. Adverse events predictors are mainly associated to patient characteristics, which might be useful for risk stratification and prognosis. Further studies are required to identify what patients might benefit from endovascular revascularization.
Original Title: Contemporary Practice Patterns and Outcomes of Endovascular Revascularization of Acute Limb Ischemia.
Reference: Matthew S. Herzig, MD et al JACC Cardiovasc Interv. 2024;17:2379–2390.
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