Hybrid Techniques versus Thrombolysis Associated with Completion Angioplasty in Treatment of Acute on Top of Chronic Lower Limb Ischemia.

Document Type : Original Article

Authors

Department of Vascular Surgery, Faculty of Medicine, Ain Shams University, Egypt

10.21608/asjs.2024.368162

Abstract

Introduction: Acute on top of chronic ischemia, is an acute dramatic deterioration of symptoms in a chronic
peripheral arterial disease (PAD) patient. The clinical presentation may be less pronounced compared to patients
with pure acute embolic occlusion. Catheter directed thrombolysis (CDT) has been added to the armamentarium
of treatment for acute limb ischaemia since the STILE and TOPAS trials. Hybrid techniques for treating acute limb
ischemia, usually at different levels, are done by combining both open surgical and endovascular techniques.
Patients and methods: A retrospective 2 arm comparative study was conducted on patients presented with limb
threatening ischemia over the course of 18 months between September 2022 to March 2024 by comparing hybrid
thrombectomy followed by completion angioplasty to catheter directed thrombolysis (CDT) followed by completion
angioplasty regarding limb salvage, complication rates and patency.
Results: A total 53 patients were divided into 2 groups. The primary outcome was the technical success that
was achieved in 21 cases (91.3%) in hybrid group compared to 23 cases (76.7%) in CDT group. The secondary
outcome was the limb salvage that was obtained in 21 cases (91.3%) in hybrid group and in 23 (76.7%) in CDT
group. Procedure related adverse events were mostly in the CDT group as distal embolization (3 cases). Both
groups had equal 30 days mortality 3 patients.
Conclusion: Although the total endovascular approach shows a slightly higher incidence of distal embolization
and bleeding complications compared to the hybrid approach, both approaches demonstrate comparable rates of
limb salvage in correlation with the stage of acute ischemia.

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