الفهرس 
ARTERIAL BLOOD SUPPLY OF THE LOWER LIMBSOnly 14 pages are availabe for public view
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Abstract
Acute limb ischemia is a challenging, highly morbid, and frequently fatal vascular emergency. Percutaneous mechanical thrombectomy devices are an alternative treatment to restore perfusion by removing thrombus in the arterial system of the limb.
This prospective randomized study was conducted on 50 patients who presented to the ER with acute thrombotic lower limb ischemia (Rutherford class I, II A) at Ain Shams University Hospitals and Helwan University Hospitals in the period between September 1st, 2021, and August 31st, 2023, to compare safety (the peri operative complications) and efficacy (the success rate, the patency rate and the limb salvage rate) of percutaneous mechanical thrombectomy versus catheter directed thrombolysis in the management of acute thrombotic lower limb ischemia..
The patients were randomized into two groups:
group A: included 25 patients, who were treated using percutaneous mechanical thrombectomy.
group B: included 25 patients, who were treated using catheter directed thrombolysis.
In the current study, the mean age was 67.16 ± 9.56 years (44-86 years) and 56.88 ± 11.38 years (36 - 81 years) in group A and group B respectively with a high significant difference (P=0.001). group A included 12 males and 13 females while group B included 14 males and 11 females with no significant differences between the studied groups. As regard risk factors, DM was the most common risk factors in group A (88.0%) followed by HTN (68%), while in group B, the most common risk factors was DM (72.0%) followed by smoking (56%), with no significant differences between the studied group.
In our study, we achieved technical success rate 96% (n=24) and 80% (n=20) in group A and group B respectively.
In the current study, only 2 patient (8%) in group A showed complications, 1 patient had perforation and the other patient had distal embolization/ trash foot, while in group B, 2 patients (8%) showed complications, 1 patient had intracranial Heamorrage and 1 patients had pseudo aneurysm.
Only 2 patients in group B died peri-operatively while no death reported in group A. 1 patient in group A and 2 patients in group B had below knee amputation. In group A, non of the patients had above knee amputation, while 3 patients in group B had above knee amputation.
In our study, at 1 month follow-up, primary patency rate was 84.0% (21/25) and 81% (17/21) in group A and group B respectively and this rate declined to 62.5% (15/24) and 55.6% (10/18) at 1 year follow up.
CONCLUSION
from the current study, it was concluded that:
D
espite that the results of percutaneous mechanical thrombectomy and catheter directed thrombolysis were comparable, percutaneous mechanical thrombectomy is considered more safe and efficient technique in the treatment of acute limb ischemia as:
Percutaneous mechanical thrombectomy was done in single session.
PMT had lower mortality and morbidity, higher limb salvage and patency rate than CDT, but in PMT special attention should be given to the potential for distal embolism.
Patients treated with PMT showed less decline in patency over the follow up period.
RECOMMENDATIONS
E
ndovascular treatment is well established for thrombus-containing ischemic lesions, whether embolic, thrombotic, acute occlusions. Thrombolysis, clot aspiration, mechanical thrombectomy, and revascularization techniques such as balloon angioplasty or stenting are the accepted techniques worldwide. Therefore, we recommend that:
Further well designed, prospective studies with a larger sample are required to validate these finding.
The Rotarex mechanical thrombectomy catheter may be the treatment of choice in elders who have contraindications to catheter directed thrombolysis as it is effective and safe modality for treating acute lower limb ischemia, with excellent immediate and satisfactory long-term results.
Catheter directed thrombolysis with shorten time of exposure may decrease incidence of bleeding.