Analysis and results of pharmacomechanical thrombectomy with AngioJet in acute arterial occlusions: a prospective comparison study among the number of cycles and outcomes

Abstract

BACKGROUND: The main objective of this present paper was to evaluate the results and outcomes of patients with acute limb ischemia (ALI) submitted to pharmacomechanical thrombectomy (PMT) endovascular surgery, regarding the number of cycles of PMT, mainly the limb salvage estimates rate and the overall survival rate, performing a comparison with patients with ALI according to the number of cycles performed during PMT technique.METHODS: Overall, 92 patients with ALI submitted to PMT were evaluated. Two groups of patients were identified: group 1 higher than 150 cycles with 60 patients and group 2 lesser than 150 cycles with 32 patients.RESULTS: The overall mortality rate (OMR) was 15.1% (13 patients) in total cohort within the first 30 days. Group 1 had a higher OMR than group 2 (16.1% versus 9.3%, P=0.007). There were 4 cases of hematuria (4.3%), all of them in group 1. We have performed a Kaplan Meier regarding limb salvage rates: Group 1 had 85% and Group 2 had 95.7% at 1057 days. P=0.081. Among the factors evaluated, the following were related to overall mortality rate: PMT with higher >150 cycles/s (HR=7.17, P=0.007, CI: 1.38-8.89), COVID-19 infection (HR=2.75, P=0.010, CI: 1.73-5.97) and postoperative acute kidney failure (HR=2.97, P<0.001, CI: 1.32-8.13). Among the factors evaluated, the following was related to limb loss: postoperative acute kidney failure (HR=4.41, P=0.036, CI: 1.771-7.132).CONCLUSIONS: Pharmacomechanical thrombectomy with AngioJet is a safe and effective therapy in patients with ALI. However, PMT higher than 150 cycles/s may be related to a higher overall mortality rate. Moreover, the main cause related to limb loss was postoperative acute kidney failure. The main factors related to overall mortality rate were PMT with higher >150 cycles/s. postoperative acute kidney failure and COVID-19 infection.