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J Endovasc Ther. 2015 Aug;22(4):546-57. doi: 10.1177/1526602815592849. Epub 2015 Jun 24.

Rheolytic Pharmacomechanical Thrombectomy for the Management of Acute Limb Ischemia: Results From the PEARL Registry.

Author information

1
Christiana Care Health Services, Newark, DE, USA dleung@christianacare.org.
2
Chilton Memorial Hospital, Pompton Plains, NJ, USA.
3
Technomics Research, LLC, Minneapolis, MN, USA.
4
Reading Hospital & Medical Center, West Reading, PA, USA.
5
Miriam Hospital, Providence, RI, USA.
6
Charleston Area Medical Center, Charleston, WV, USA.
7
Christiana Care Health Services, Newark, DE, USA.
8
Mount Sinai Medical Center, New York, NY, USA.
9
Pennsylvania State University and the Milton S. Hershey Medical Center, Hershey, PA, USA.

Abstract

PURPOSE:

To present the results of rheolytic pharmacomechanical thrombectomy (PMT) for the management of acute limb ischemia (ALI) as reported in the PEARL Registry (PEripheral Use of AngioJet Rheolytic Thrombectomy with a variety of catheter Lengths).

METHODS:

A total of 283 patients (mean age 65±13 years; 170 men) presenting with ALI undergoing treatment with the AngioJet System at participating institutions were enrolled in the registry. Rutherford ALI categories included 26% with viable limbs, 38% with marginally threatened limbs, 35% with immediately threatened limbs, and <1% with irreversible damage. Procedure and follow-up data were collected for the calculation of outcomes. To control for patient selection bias, propensity score matching was used to compare outcomes for patients undergoing PMT with or without catheter-directed thrombolysis (CDT).

RESULTS:

Procedure success was achieved in 235 (83%) of 283 patients. Half of the procedures (147, 52%) were completed without the need for adjunctive CDT. At 12-month follow-up, amputation-free survival and freedom from mortality were 81% and 91%, respectively; 12-month freedom from bleeding requiring transfusion was 91%, and freedom from renal failure was 95%. Subgroup analysis revealed significantly better outcomes in patients without infrapopliteal involvement and those who underwent PMT without CDT. In the matched cohorts, higher rates of procedure success, 12-month amputation-free survival, and 12-month freedom from amputation were observed in the PMT without CDT group (88% vs 74%, p=0.021; 87% vs 72%, p=0.028; 96% vs 81%, p=0.01, respectively).

CONCLUSIONS:

The results support the use of PMT as a first-line treatment for ALI, providing a rapid reperfusion to the extremity, reduced procedure time, and an acceptable risk profile without compromising limb salvage.

KEYWORDS:

AngioJet thrombectomy; acute limb ischemia; amputation; arterial thrombosis; catheter-directed thrombolysis; mechanical thrombectomy; mortality; rheolytic thrombectomy; thrombotic occlusion

PMID:
26109628
DOI:
10.1177/1526602815592849
[Indexed for MEDLINE]

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