Percutaneous-aspiration thrombectomy for acute and subacute lower-limb ischemia: feasibility and mid-term results

Introduction
Thromboembolic occlusions of the peripheral arteries are an important cause of acute lower-limb ischemia (ALI). Different treatment strategies were implemented in management of this critical situation, including open surgery, percutaneous endovascular approaches, and hybrid techniques with variable outcomes.
Aim
To evaluate the feasibility and effectiveness of percutaneous vacuum-aspiration mechanical thrombectomy with Indigo system in cases presented with acute and sub-ALI due to thromboembolic occlusion of different arterial territories of lower limbs, including native arteries, in-stent thrombosis, and synthetic bypass grafts with assessment of early and mid-term results.
Patients and methods
A retrospective analysis was made that includes patients presented to vascular surgery units at our facilities diagnosed with ALI due to thromboembolic occlusion class I and IIA, from June 2019 to November 2020, and were treated by percutaneous-aspiration thrombectomy using penumbra vacuum-aspiration catheter. The data were collected from electronic patients’ files, analyzed, and presented.
Results
A total of 19 patients (15 males and four females with mean age 57±9.5 years) have been identified during the period from June 2019 to November 2020. In total, nine (47.4%) patients were clinically diagnosed as having ALI of Rutherford stage I, while the other 10 (52.6%) patients were having acute ischemia Rutherford stage IIA. The average duration of limb ischemia from onset of pain till the time at hospital presentation was an average of 5.3±4 days. The level of arterial occlusion was at the iliac artery in eight (42.1%) cases, four cases with native-artery iliac occlusions, four cases of occluded common iliac artery (CIA) metal stents, femoral artery was occluded in three (15.8%) cases, popliteal artery in five (26.4%) cases, and femoropopliteal bypass synthetic grafts made of polytetrafluoroethylene in three (15.8%) cases. In most of the cases (12 patients, 63.3%) we have used CAT8 (115 cm, XTORQ tip) catheter, while in seven cases, we have used CAT6 (135 cm) catheter. Postaspiration, dilation balloon angioplasty was done in seven (36.7%) patients with 11 (68%) patients who needed stent insertion. Technical success was achieved in 18 (94.7%) patients out of 19 cases with only one (5.3%) patient with failure and the procedure was converted to open-surgical embolectomy. No major procedure-related complications were encountered, except for one (5.3%) case of access-site hematoma that was managed conservatively.
Conclusion
Indigo system can be a safe and effective alternative to surgery for treating acute nonthreatening lower-limb acute ischemia.