Comparative Outcomes of Infusion Catheter-Directed Thrombolysis and Ultrasound-Enhanced Catheter-Directed Thrombolysis in Acute Limb Ischemia: A 10-Year Single Institution Retrospective Analysis

IF 1.6 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

Annals of vascular surgery Pub Date : 2026-04-01 Epub Date: 2025-12-20 DOI:10.1016/j.avsg.2025.12.013

Zackery Aldaher, Michelle Patel, Sweta Munagapati, Bhargav Doddala, Gautam Agarwal, William Jordan, Omar El Shazly

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引用次数: 0

Abstract

Background

Standard catheter-directed thrombolysis (CDT) (S-CDT) is widely accepted as a safer alternative to open surgery for acute limb ischemia (ALI), but data on ultrasound-enhanced CDT (UE-CDT) for limb salvage are limited. This study compares outcomes of UE-CDT versus S-CDT.

Methods

A 10-year single institution retrospective review identified 68 adult patients who underwent 93 CDT events for ALI, including 62 with UE-CDT and 22 with S-CDT. Following intervention, inpatient, 30 day, and 90 day outcomes were compared; one outcome for comparison was major adverse limb events (MALEs) defined as amputation of any type.

Results

No significant differences were observed between UE-CDT and S-CDT in hospital stay (5.6 vs. 7.1 days, P = 0.31), intensive care unit stay (2.5 vs. 2.9 days, P = 0.26), or duration of thrombolysis (24.2 vs. 29.6 hours, P = 0.39). Technical success was achieved in 92% of UE-CDT cases and 95% of S-CDT cases. At 30 days, UE-CDT patients had significantly fewer MALEs compared to S-CDT (6.5% vs. 31.8%; P = 0.01). However, when amputation type was stratified between digit amputation versus above/below knee amputation, there was only a significant difference between digit amputations in the S-CDT compared to UE-CDT at 30 days (P = 0.004). Otherwise, there was no significant difference between the groups at 30 and 90 days when comparing rates of above ankle amputations.

Conclusion

UE-CDT and S-CDT for ALI show similar hospital and procedural outcomes. However, UE-CDT is associated with lower 30-day MALE, driven by reduced digit amputations, and becomes nonsignificant when stratifying by above ankle amputations.

查看原文本刊更多论文

输注导管定向溶栓和超声增强导管定向溶栓治疗急性肢体缺血的比较结果：一项10年单一机构回顾性分析。

背景：标准导管定向溶栓（S-CDT）被广泛接受为急性肢体缺血（ALI）的开放手术更安全的替代方案，但超声增强CDT （UE-CDT）用于肢体保留的数据有限。本研究比较了UE-CDT和S-CDT的结果。方法：一项为期10年的单机构回顾性研究确定了68名因ALI接受了93次CDT事件的成年患者，其中62例为UE-CDT， 22例为S-CDT。干预后，比较住院、30天和90天的结果；比较的一个结果是主要肢体不良事件（MALE），定义为任何类型的截肢。结果：UE-CDT和S-CDT在住院时间（5.6天对7.1天，p=0.31）、ICU住院时间（2.5天对2.9天，p=0.26）和溶栓时间（24.2小时对29.6小时，p=0.39）方面均无显著差异。92%的UE-CDT病例和95%的S-CDT病例取得了技术上的成功。在30天，与S-CDT患者相比，UE-CDT患者的MALE显著减少（6.5% vs. 31.8%; p=0.01）。然而，当截肢类型在手指截肢与膝盖上下截肢之间分层时，30天手指截肢与UE-CDT相比，S-CDT只有显著差异（p=0.004）。另外，30天和90天时，两组间比较踝关节以上截肢率无显著差异。结论：UE-CDT和S-CDT对ALI的医院和手术结果相似。然而，UE-CDT与较低的30天MALE相关，由手指复位截肢驱动，并且在踝关节以上截肢分层时变得不显著。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of vascular surgery 医学-外科

CiteScore

3.00

自引率

13.30%

发文量

603

审稿时长

50 days

期刊介绍： Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal: Clinical Research (reports of clinical series, new drug or medical device trials) Basic Science Research (new investigations, experimental work) Case Reports (reports on a limited series of patients) General Reviews (scholarly review of the existing literature on a relevant topic) Developments in Endovascular and Endoscopic Surgery Selected Techniques (technical maneuvers) Historical Notes (interesting vignettes from the early days of vascular surgery) Editorials/Correspondence