Catheter-directed Thrombolysis Versus Surgical Thrombectomy For Acute Lower Limb Ischemia:Comparison Of Clinical Effect

Objective: To compare the efficacy and safety of surgical thrombectomy with catheter-directed thrombolysis(CDT)for acute lower limb ischemia(ALLI).Methods: The clinical data of 107 patients with ALLI,who underwent CDT or surgical thrombectomy at authors’ department from January 2012 to December 2017,were retrospectively analyzed.The incidence of complications,mortality,reintervention rate and amputation rate within 30 days after operation were calculated.Cooley standard of efficacy score was used to assess the clinical curative effect of patients with grade Ⅱ of American Association of Vascular Surgeons(SVS)and International Society of Cardiovascular Surgery(ISCVS)classification of acute limb ischemia.Results: A total of 107 patients with ALLI were enrolled in this study.Among them,59 patients received CDT therapy and 48 patients receivedsurgical thrombectomy.The technical success rate of both groups was100%.Within 30 days after operation,the incidence of complications in CDT group and surgical thrombectomy group was 11.9% and 14.6%respectively,the mortality was 5.1% and 6.3% respectively,and the reintervention rate was 17.0% and 22.9% respectively,all the differences were not statistically significant(P>0.05).The amputation rate of patients with grade Ⅱ of SVS/ISCVS ischemia classification in CDT group was8.9%,which was higher than 2.3% in surgical thrombectomy group,but the difference between the two groups was not statistically significant(P>0.05).In patients with grade Ⅱ of ischemia assessed by the causes and Cooley curative effect standard at the time of discharge,the cure percentage of embolism-caused ALLI patients in surgical thrombectomy group was 82.5%,which was remarkably higher than 62.8% in CDT group(P<0.05).The cure percentage of thrombosis-caused ALLI patients in CDT group was 92.3%,which was strikingly higher than 25.0% in surgical thrombectomy group(P <0.05).The difference in the improvement of ischemia,which was assessed by the duration of ischemia and Cooley therapeutic criteria at the time of discharge,between the two groups was not statistically significant(P>0.05).Conclusion: In treating ALLI,no significant differences in curative effect,incidence of postoperative complications and mortality exist between surgical thrombectomy and CDT.The formulation of therapeuticregimen should be based on ischemia grade of SVS/ISCVS,etiology and coexisting underlying diseases.