Long-term results of percutaneous thrombo-embolectomy in patients with infrainguinal embolic occlusions

Background. The aim of the study was to review early and long term clinical results of percutaneous thrombo-embolectomy in patients with acute embolic occlusions of the infrainguinal arteries. Methods. Retrospective analysis of consecutive cases. A total of 88 procedures in 84 patients were perfomed between 1986 and 1996 in a University Hospital (46 men, 42 women; mean age 67.6±14.4 years). Patients with a history of chronic symptomatic arterial occlusive disease were not included in the analysis. Indications for treatment were severe claudication (n=45 procedures) and limb threatening ischaemia (n=43 procedures). Percutaneous thrombo-embolectomy was performed via an ipsilateral approach by means of an endhole aspiration catheter. Local thrombolysis or balloon angioplasty was used as appropriate during the intervention. Follow-up included clinical data, ankle pressure measurements, pulse volume recordings and duplex sonography or angiography if indicated. Results. Technical success was achieved in 85 (96.6%) of the 88 procedures. Two patients (2.3%) suffered major and two patients (2.3%) minor complications. One patient died within 30 days after the procedure. Mean follow-up was 3.7±2.9 years. Twelve patients (16%) were lost to follow-up. Primary clinical success rate was 88.4% at one and 81.7% at two years and declined to 76.5% at eight years. Out of the 16 interval failures 10 (63%) were due to recurrent embolism to the same leg. They resulted in nine catheter reinterventions and one bypass graft. Six patients were treated conservatively. Cumulative mortality was 11.7% at one year and increased to 29.5% at eight years. Conclusions. From our single centre experience we conclude that catheter treatment of acute embolic occlusion of infrainguinal arteries is safe and has favourable longterm results. We therefore regard the technique as a less invasive alternative to surgery.