Abstract
Purpose
To evaluate a new endovascular strategy utilizing a hybrid procedure for long segmental arterial thromboembolism in a lower extremity by historical comparison with conventional endovascular strategy.
Materials and methods
In a new endovascular strategy, a hybrid procedure was performed for long segmental thromboembolism (longer than 15 cm) and an endovascular procedure for short segmental thromboembolism. The new strategy group (Group A) consisted of 24 procedures (13 hybrid procedures, 11 endovascular procedures) in 19 patients. Data were retrospectively collected from 24 consecutive procedures in 23 patients treated with the conventional strategy (Group B).
Result
The technical success of Groups A and B was 24/24 and 20/24, respectively (p = 0.11). Major amputation or mortality was not observed in Group A, whereas 3 major amputations and 4 deaths occurred in Group B. Clinical failure in Groups A and B was 0/24 and 7/24, respectively (p < 0.05). Continuous urokinase (UK) infusion was needed in 1/24 in Group A and 14/24 in Group B (p < 0.05). Mean procedure time was 4 h 17 min for Group A and 21 h 30 min for Group B (p < 0.05).
Conclusion
The hybrid procedure may be faster and more effective than the conventional treatment in long segmental arterial thromboembolisms, while the conventional treatment is still effective for short segmental occlusions.
Similar content being viewed by others
References
Setacci C, De Donato G, Setacci F, Sirignano P, Galzerano G. Hybrid procedures for acute limb ischemia. J Cardiovasc Surg (Torino). 2012;53(1 Suppl 1):133–43.
Creager MA, Kaufman JA, Conte MS. Clinical practice. Acute limb ischemia. N Engl J Med. 2012;366:2198–206.
Argyriou C, Georgakarakos E, Georgiadis GS, Antoniou GA, Schoretsanitis N, Lazarides M. Hybrid revascularization procedures in acute limb ischemia. Ann Vasc Surg. 2014;28:1456–62.
Matsagkas M, Kouvelos G, Arnaoutoglou E, Papa N, Labropoulos N, Tassiopoulos A. Hybrid procedures for patients with critical limb ischemia and severe common femoral artery atherosclerosis. Ann Vasc Surg. 2011;25:1063–9.
Sacks D, Marinelli DL, Martin LG, Spies JB, Society of Interventional Radiology Technology Assessment C. Reporting standards for clinical evaluation of new peripheral arterial revascularization devices. J Vasc Interv Radiol. 2003;14(9 Pt 2):S395–404.
Patel N, Sacks D, Patel RI, Moresco KP, Ouriel K, Gray R, et al. SIR reporting standards for the treatment of acute limb ischemia with use of transluminal removal of arterial thrombus. J Vasc Interv Radiol. 2003;14(9 Pt 2):S453–65.
Argyriou C, Georgakarakos E, Georgiadis GS, Antoniou GA, Schoretsanitis N, Lazarides M. Hybrid revascularization procedures in acute limb ischemia. Ann Vasc Surg. 2014;28:1456–62.
Hynes BG, Margey RJ, Ruggiero N 2nd, Kiernan TJ, Rosenfield K, Jaff MR. Endovascular management of acute limb ischemia. Ann Vasc Surg. 2012;26:110–24.
Blaisdell FW, Steele M, Allen RE. Management of acute lower extremity arterial ischemia due to embolism and thrombosis. Surgery. 1978;84:822–34.
Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial. Ann Surg. 1994;220:251–66 (discussion 66–8).
Nilsson L, Albrechtsson U, Jonung T, Ribbe E, Thorvinger B, Thorne J, et al. Surgical treatment versus thrombolysis in acute arterial occlusion: a randomised controlled study. Eur J Vasc Surg. 1992;6:189–93.
Ouriel K, Shortell CK, DeWeese JA, Green RM, Francis CW, Azodo MV, et al. A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia. J Vasc Surg. 1994;19:1021–30.
Ouriel K, Veith FJ, Sasahara AA. Thrombolysis or peripheral arterial surgery: phase I results. TOPAS Investigators. J Vasc Surg. 1996;23:64–73 (discussion 4–5).
Ouriel K, Veith FJ, Sasahara AA. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med. 1998;338:1105–11.
de Donato G, Setacci F, Sirignano P, Galzerano G, Massaroni R, Setacci C. The combination of surgical embolectomy and endovascular techniques may improve outcomes of patients with acute lower limb ischemia. J Vasc Surg. 2014;59:729–36.
Swischuk JL, Fox PF, Young K, Hussain S, Smouse B, Castaneda F, et al. Transcatheter intra-arterial infusion of rt-PA for acute lower limb ischemia: results and complications. J Vasc Interv Radiol. 2001;12:423–30.
Ouriel K, Gray B, Clair DG, Olin J. Complications associated with the use of urokinase and recombinant tissue plasminogen activator for catheter-directed peripheral arterial and venous thrombolysis. J Vasc Interv Radiol. 2000;11:295–8.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
About this article
Cite this article
Kwak, J., Chung, H., Lee, S. et al. A new endovascular strategy utilizing a hybrid procedure for long segmental occlusion by acute arterial thromboembolism in the lower extremity. Jpn J Radiol 34, 494–502 (2016). https://doi.org/10.1007/s11604-016-0542-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-016-0542-6