Comparative analysis of endovascular methods for treatment of acute lower limb ischemia

Abstract

Acute lower limb ischemia (ALLI) is defined as a sudden decrease in lower limb arterial perfusion, which lasts less than 14 days and threatens a limb viability. This condition is one of the most common emergencies in vascular surgery, requiring immediate diagnosis and treatment, because untimely revascularization of lower limb leads to high amputation rate and mortality in postoperative period.

Currently there exist many methods of lower limb revascularization, however, in fact, they all can be divided into two large groups: open, surgical, and endovascular treatment. The choice between them depends on many factors. Since introduction of Fogarty catheter, balloon thromboembolectomy became a «gold standard» in treatment for ALLI. Nevertheless, at the same time endovascular methods appeared, the first one being catheter-based thrombolysis (CBT). Since its appearance, CBT gradually improved with deeper understanding of indications for its use, improvement of the technique of intervention, appearance of different thrombolytic agents and instruments. Nowadays a number of international guidelines determine CBT as a first line treatment of most patients with ALLI.

Endovascular thrombectomy techniques appeared in the 90s of XX century as an attempt tocombine advantages of open surgery (rapid and, in ideal conditions, complete restoration of limb perfusion) and of endovascular intervention (minimal invasiveness). They include manual aspiration, rheolytic (hydrodynamic), rotational, aspiration thrombectomy and pharmacomechanical thrombolysis. According to numerous studies, these techniques demonstrate quite impressive results and, probably, in the near future one of them can become a new «gold standard» in treatment for ALLI.

Keywords

acute lower limb ischemia / endovascular treatment / catheter-based thrombolysis / mechanical thrombectomy / ultrasound-accelerated thrombolysis / pharmacomechanical thrombolysis

References

[1] Gilliland C, Shah J, Martin JG, et al. Acute Limb Ischemia. Techniques in Vascular and Interventional Radiology. 2017;20(4):274-80. doi:10.1053/j.tvir. 2017.10.008

[2] Gilliland C., Shah J., Martin J.G., et al. Acute Limb Ischemia // Techniques in Vascular and Interventional Radiology. 2017. Vol. 20, №4. P. 274-280. doi:10.1053/j.tvir.2017.10.008

[3] Kalinin RE, Suchkov IA, Boguto ON. Embolism of main arteries in atrial fibrillation. I.P. Pavlov Russian Medical Biological Herald. 2012;(2):234-41. (In Russ). doi:10.17816/PAVLOVJ20122234-241

[4] Калинин Р.Е., Сучков И.А., Богуто О.Н. Эмболия магистральных артерий при фибрилляции предсердий // Российский медико-биологический вест-ник имени академика И.П. Павлова. 2012. №2. С. 234-241. doi:10.17816/PAVLOVJ20122234-241

[5] Lukasiewicz A. Treatment of acute lower limb ischemia. Vasa. 2016;45(3):213-21. doi:10.1024/ 0301-1526/a000527

[6] Lukasiewicz A. Treatment of acute lower limb ischemia // Vasa. 2016. Vol. 45, №3. P. 213-221. doi:10.1024/0301-1526/a000527

[7] Pearse HE. Embolectomy for Arterial Embolism of the Extremities. Annals of Surgery. 1933;98(1):17-32.

[8] Pearse H.E. Embolectomy for Arterial Embolism of the Extremities // Annals of Surgery. 1933. Vol. 98, №1. P. 17-32.

[9] Nebylitsin YuS, Lazuko S.S., Kut'ko E.A. Sindrom ishemii-reperfuzii nizhnikh konechnostey. Vestnik VGMU. 2018;17(6):18-31. (In Russ). doi:10.22263/ 2312-4156.2018.6.18

[10] Небылицин Ю.С., Лазуко С.С., Кутько Е.А. Синдром ишемии-реперфузии нижних конечностей // Вестник ВГМУ. 2018. Т. 17, №6. С. 18-31. doi:10.22263/2312-4156.2018.6.18

[11] Fogarty T.J., Cranley J.J. Catheter technic for arterial embolectomy. Annals of Surgery. 1965;161 (3):325-30.

[12] Fogarty T.J., Cranley J.J. Catheter technic for arterial embolectomy // Annals of Surgery. 1965. Vol. 161, №3. P. 325-330.

[13] Gerhard-Herman MD, Gornik HL, Barrett C et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12):e686-e725. doi:10.1161/CIR. 0000000000000470

[14] Gerhard-Herman M.D., Gornik H.L., Barrett C., et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines // Circulation. 2017. Vol. 135, №12. P. e686-e725. doi:10.1161/CIR.0000000000000470

[15] Aboyans V, Ricco J, Bartelink MEL, et al. ESC Scientific Document Group; 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. European Heart Journal. 2018;39(9):763-816. doi:10.1093/eurheartj/ehx095

[16] Aboyans V., Ricco J., Bartelink M.E.L., et al. ESC Scientific Document Group; 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries // European Heart Journal. 2018. Vol. 39, №9. P. 763-816. doi:10.1093/ eurheartj/ehx095

[17] Hage A, McDevitt J, Chick J, et al. Acute limb ischemia therapies: when and how to treat endo-vascularly. Seminars in Interventional Radiology. 2018;35(5):453-60. doi:10.1055/s-0038-1676321

[18] Hage A., McDevitt J., Chick J., et al. Acute limb ische-mia therapies: when and how to treat endovasculary // Seminars in Interventional Radiology. 2018. Vol. 35, №5. P. 453-460. doi:10.1055/s-0038-1676321

[19] Berridge DC, Hopkinson BR, Makin GS et al. Randomized trial of intra-arterial recombinant tissue plasminogen activator, intravenous recombinant tissue plasminogen activator and intra-arterial streptokinase in peripheral arterial thrombolysis. The British Journal of Surgery. 1991;78(8):988-95. doi:10.1002/ bjs.1800780831

[20] Berridge D.C., Hopkinson B.R., Makin G.S., et al. Randomized trial of intra-arterial recombinant tissue plasminogen activator, intravenous recombinant tissue plasminogen activator and intra-arterial streptokinase in peripheral arterial thrombolysis // The British Journal of Surgery. 1991. Vol. 78, №8. P. 988-995. doi:10.1002/bjs.1800780831

[21] Patel NH, Krishnamurthy VN, Kim S et al. Quality improvement guidelines for percutaneous management of acute lower-extremity ischemia. Journal of Vascular and Interventional Radiology. 2013;24 (1):3-15. doi:10.1016/j.jvir.2012.09.026

[22] Patel N.H., Krishnamurthy V.N., Kim S., et al. Quality improvement guidelines for percutaneous management of acute lower-extremity ischemia // Journal of Vascular and Interventional Radiology. 2013. Vol. 24, №1. P. 3-15. doi:10.1016/j.jvir.2012. 09.026

[23] Robertson I, Kessel DO, Berridge DC. Fibrinolytic agents for peripheral arterial occlusion. Cochrane Database of Systematic Reviews. 2013;12. doi:10. 1002/14651858.CD001099.pub3

[24] Robertson I., Kessel D.O., Berridge D.C. Fibrino-lytic agents for peripheral arterial occlusion. Cochrane Database of Systematic Reviews. 2013. Vol. 12. doi:10.1002/14651858.CD001099.pub3

[25] Yusuf SW, Whitaker SC, Gregson RHS, et al. Prospective randomised comparative study of pulse spray and conventional local thrombolysis. European Journal of Vascular and Endovascular Surgery. 1995;10(2):136-41. doi:10.1016/s1078-5884 (05)80104-2

[26] Yusuf S.W., Whitaker S.C., Gregson R.H.S., et al. Prospective randomised comparative study of pulse spray and conventional local thrombolysis // European Journal of Vascular and Endovascular Surgery. 1995. Vol. 10, №2. P. 136-141. doi:10.1016/ s1078-5884(05)80104-2

[27] Valle JA, Waldo SW. Current endovascular management of acute limb ischemia. Interventional Cardiology Clinics. 2017;6(2):189-96. doi:10.1016/ j.iccl.2016.12.003

[28] Valle J.A., Waldo S.W. Current endovascular mana-gement of acute limb ischemia // Interventional Cardiology Clinics. 2017. Vol. 6, №2. P. 189-196. doi:10.1016/j.iccl.2016.12.003

[29] Kessel DO, Berridge DC, Robertson I. Infusion techniques for peripheral arterial thrombolysis (Review). Cochrane Database of Systematic Reviews. 2004;1. doi:10.1002/14651858.CD000985.pub2

[30] Kessel D.O., Berridge D.C., Robertson I. Infusion techniques for peripheral arterial thrombolysis (Review) // Cochrane Database of Systematic Reviews. 2004. Vol. 1. doi:10.1002/14651858.CD000985.pub2

[31] Goldstein JN, Marrero M, Masrur S et al. Management of thrombolysis-associated symptomatic intra-cerebral hemorrhage. Archives of Neurology. 2010; 67(8):965-69. doi:10.1001/archneurol.2010.175

[32] Goldstein J.N., Marrero M., Masrur S., et al. Management of thrombolysis-associated symptomatic intracerebral hemorrhage // Archives of Neurology. 2010. Vol. 67, №8. P. 965-969. doi:10.1001/ archneurol.2010.175

[33] Kazakov YuI, Kazakov AYu, Nefedov VI, et al. Surgical approach to management of patients with acute arterial ischemia of lower limbs with the underlying atherosclerotic lesion of arteries. Nauka molodykh (Eruditio Juvenium). 2019;7(1):86-92. (In Russ). doi:10.23888/HMJ20197186-92

[34] Казаков Ю.И., Казаков А.Ю., Нефедов В.И., и др. Хирургическая тактика ведения пациентов с острой артериальной ишемией нижних конечностей на фоне атеросклеротического поражения артерий // Наука молодых (Eruditio Juvenium). 2019. Т. 7, №1. С. 86-92. doi:10.23888/HMJ20197186-92

[35] Doomernik DE, Schrijver AM, Zeebregts CJ et al. Advancements in catheter-directed ultrasound accelerated thrombolysis. Journal of Endovascular Therapy. 2011;18(3):418-34. doi:10.1583/10-3362.1

[36] Doomernik D.E., Schrijver A.M., Zeebregts C.J., et al. Advancements in Catheter-Directed Ultrasound Accelerated Thrombolysis // Journal of Endovas-cular Therapy. 2011. Vol. 18, №3. P. 418-434. doi:10.1583/10-3362.1

[37] Wissgott C, Richter A, Kamusella P et al. Treatment of Critical Limb Ischemia Using Ultrasound-Enhanced Thrombolysis (PARES Trial): Final Results. Journal of Endovascular Therapy. 2007;14 (4):438-43. doi:10.1177/152660280701400402

[38] Wissgott C., Richter A., Kamusella P., et al. Treatment of Critical Limb Ischemia Using Ultrasound-Enhanced Thrombolysis (PARES Trial): Final Results // Journal of Endovascular Therapy. 2007. Vol. 14, №4. P. 438-443. doi:10.1177/152660280701400402

[39] Schrijver AM, van Leersum M, Fioole B, et al. Dutch Randomized Trial Comparing Standard Catheter-Directed Thrombolysis and Ultrasound-Accelerated Thrombolysis for Arterial Thromboembolic Infrainguinal Disease (DUET). Journal of Endovascular Therapy. 2015;22(1):87-95. doi:10. 1177/1526602814566578

[40] Schrijver A.M., van Leersum M., Fioole B., et al. Dutch Randomized Trial Comparing Standard Catheter-Directed Thrombolysis and Ultrasound-Accelerated Thrombolysis for Arterial Thromboembolic Infrainguinal Disease (DUET) // Journal of Endovascular Therapy. 2015. Vol. 22, №1. P. 87-95. doi:10.1177/1526602814566578

[41] Vorwerk D, Triebe S, Ziegler S, et al. Percutaneous mechanical thromboembolectomy in acute lower limb ischemia. CardioVascular and Interventional Radiology. 2019;42(2):178-85. doi:10.1007/s00270 -018-2129-3

[42] Vorwerk D., Triebe S., Ziegler S., et al. Percutaneous mechanical thromboembolectomy in acute lower limb ischemia // Cardiovascular and Interventional Radiology. 2019. Vol. 42, №2. P. 178-185. doi:10.1007/s00270 -018-2129-3

[43] Allie DE, Hebert CJ, Lirtzman MD et al. Novel simultaneous combination chemical thrombolysis/rheolytic thrombectomy therapy for acute critical limb ischemia: the power pulse-spray technique. Catheterization and Cardiovascular Interventions. 2004;63(4):512-22. doi:10.1002/ccd.20216

[44] Allie D.E., Hebert C.J., Lirtzman M.D., et al. Novel simultaneous combination chemical thrombolysis/ rheolytic thrombectomy therapy for acute critical limb ischemia: the power pulse-spray technique // Catheterization and Cardiovascular Interventions. 2004. Vol. 63, №4. P. 512-522. doi:10.1002/ccd.20216

[45] Silva JA, Ramee SR, Collins TJ, et al. Rheolytic thrombectomy in the treatment of acute limb-threatening ischemia: immediate results and six-month follow-up of the multicenter AngioJet registry. Possis Peripheral AngioJet Study AngioJet Investigators. Catheterization and Cardiovascular Diagnosis. 1998;45(4):386-93.

[46] Silva J.A., Ramee S.R., Collins T.J., et al. Rheolytic thrombectomy in the treatment of acute limb-threatening ischemia: immediate results and six-month follow-up of the multicenter AngioJet registry. Possis Peripheral AngioJet Study AngioJet Investigators // Catheterization and Cardiovascular Diagnosis. 1998. Vol. 45, №4. P. 386-393.

[47] Leung DA, Blitz LR, Nelson T, et al. Rheolytic Pharmacomechanical Thrombectomy for the Management of Acute Limb Ischemia: Results From the PEARL Registry. Journal of Endovascular Therapy. 2015;22(4):546-57. doi:10.1177/1526602815592849

[48] Leung D.A., Blitz L.R., Nelson T., et al. Rheolytic Pharmacomechanical Thrombectomy for the Management of Acute Limb Ischemia: Results From the PEARL Registry // Journal of Endovascular Therapy. 2015. Vol. 22, №4. P. 546-557. doi:10.1177/ 1526602815592849

[49] Gandhi SS, Ewing JA, Cooper E, et al. Comparison of Low-Dose Catheter-Directed Thrombolysis with and without Pharmacomechanical Thrombectomy for Acute Lower Extremity Ischemia. Annals of Vascular Surgery. 2018;46:178-86. doi:10.1016/ j.avsg.2017.07.008

[50] Gandhi S.S., Ewing J.A., Cooper E., et al. Comparison of Low-Dose Catheter-Directed Thrombolysis with and without Pharmacomechanical Thrombec-tomy for Acute Lower Extremity Ischemia // Annals of Vascular Surgery. 2018. Vol. 46. P. 178-186. doi:10.1016/j.avsg.2017.07.008

[51] Lichtenberg M, Stahlhoff F-W, Boese D. Endovascular treatment of acute limb ischemia and proximal deep vein thrombosis using rotational thrombec-tomy: a review of published literature. Cardiovascular Revascularization Medicine. 2013;14(6):343-8. doi:10.1016/j.carrev.2013.08.005

[52] Lichtenberg M., Stahlhoff F.W., Boese D. Endovascular treatment of acute limb ischemia and proximal deep vein thrombosis using rotational thrombec-tomy: a review of published literature // Cardiovascular Revascularization Medicine. 2013. Vol. 14, №6. P. 343-348. doi:10.1016/j.carrev. 2013.08.005

[53] Heller S, Lubanda JC, Varejka P, et al. Percutaneous Mechanical Thrombectomy Using Rotarex® S Device in Acute Limb Ischemia in Infrainguinal Occlusions. BioMed Research International. 2017; 3. doi:10.1155/2017/2362769

[54] Heller S., Lubanda J.C., Varejka P., et al. Percutaneous Mechanical Thrombectomy Using Rotarex® S Device in Acute Limb Ischemia in Infrainguinal Occlusions // BioMed Research International. 2017. Vol. 3. doi:10.1155/2017/2362769

[55] Freitas B, Steiner S, Bausback Y, et al. Rotarex Mechanical Debulking in Acute and Subacute Arterial Lesions. Angiology. 2016;68(3):233-41. doi:10. 1177/0003319716646682

[56] Freitas B., Steiner S., Bausback Y., et al. Rotarex Mechanical Debulking in Acute and Subacute Arterial Lesions // Angiology. 2016. Vol. 68, №3. P. 233-241. doi:10.1177/0003319716646682

[57] Kronlage M, Printz I, Vogel B, et al. A comparative study on endovascular treatment of (sub)acute critical limb ischemia: mechanical thrombectomy vs thrombolysis. Drug Design, Development and Therapy. 2017;11:1233-41. doi:10.2147/dddt.s131503

[58] Kronlage M., Printz I., Vogel B., et al. A comparative study on endovascular treatment of (sub)acute critical limb ischemia: mechanical thrombectomy vs thrombolysis // Drug Design, Development and Therapy. 2017. Vol. 11. P. 1233-1241. doi:10. 2147/dddt.s131503

[59] Giusca S, Raupp D, Dreyer D, et al. Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries. World Journal of Cardiology. 2018;10(10):145-52. doi:10.4330/wjc.v10.i10.145

[60] Giusca S., Raupp D., Dreyer D., et al. Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries // World Journal of Cardiology. 2018. Vol. 10, №10. P. 145-152. doi:10.4330/ wjc.v10.i10.145

[61] Teymen B, Aktürk S. Treatment of infrainguinal arterial thromboembolic acute occlusions with the Aspirex® mechanical thrombectomy device. Acta Cardiologica. 2017;72(6):649-54. doi:10.1080/000 15385.2017.1318006

[62] Teymen B., Aktürk S. Treatment of infrainguinal arterial thromboembolic acute occlusions with the Aspirex® mechanical thrombectomy device // Acta Cardiologica. 2017. Vol. 72, №6. P. 649-654. doi:10.1080/000 15385.2017.1318006

[63] Bhaskar S, Stanwell P, Cordato D, et al. Reperfusion therapy in acute ischemic stroke: dawn of a new era? BMC Neurology. 2018;18(1):8. doi:10. 1186/s12883-017-1007-y

[64] Bhaskar S., Stanwell P., Cordato D., et al. Reperfusion therapy in acute ischemic stroke: dawn of a new era? // BMC Neurology. 2018. Vol. 18, №1. P. 8. doi:10.1186/s12883-017-1007-y

[65] Baumann F, Sharpe E III, Pena C, et al. Technical results of vacuum-assisted thrombectomy for arterial clot removal in patients with acute limb ischemia. Journal of vascular and interventional radiology. 2016;27:330-5. doi:10.1016/j.jvir.2015.11.061

[66] Baumann F., Sharpe E. III, Pena C., et al. Technical results of vacuum-assisted thrombectomy for arterial clot removal in patients with acute limb ischemia // Journal of Vascular and Interventional Ra-diology. 2016. Vol. 27. P. 330-335. doi:10.1016/ j.jvir.2015.11.061

[67] Adams GL. Final results of the PRISM trial for novel aspiration thrombectomy in treatment of peripheral and visceral arterial occlusions. In: Archive Leipzig Interventional Course. Vol. 26-29. Jan 2016; Leipzig, Germany.

[68] Adams G.L. Final results of the PRISM trial for novel aspiration thrombectomy in treatment of peripheral and visceral arterial occlusions. In: Archive Leipzig Interventional Course. Vol. 26-29. Jan 2016; Leipzig, Germany.

[69] Kwok CHR, Fleming S, Chan KKC, et al. Aspiration Thrombectomy versus Conventional Catheter-Directed Thrombolysis as First-Line Treatment for Noniatrogenic Acute Lower Limb Ischemia. Journal of Vascular and Interventional Radiology. 2018;29(5):607-13. doi:10.1016/j.jvir.2017.11.030

[70] Kwok C.H.R., Fleming S., Chan K.K.C., et al. Aspiration Thrombectomy versus Conventional Catheter-Directed Thrombolysis as First-Line Treatment for Noniatrogenic Acute Lower Limb Ischemia // Journal of Vascular and Interventional Radiology. 2018. Vol. 29, №5. P. 607-613. doi:10.1016/ j.jvir.2017.11.030

[71] Gupta R, Hennebry TA. Percutaneous isolated pharmaco-mechanical thrombolysis-thrombectomy system for the management of acute arterial limb ischemia: 30-day results from a single-center experience. Catheterization and Cardiovascular Interventions. 2012;80(4):636-43. doi:10.1002/ccd.24283

[72] Gupta R., Hennebry T.A. Percutaneous isolated pharmaco-mechanical thrombolysis-thrombectomy system for the management of acute arterial limb ischemia: 30-day results from a single-center experience // Catheterization and Cardiovascular Interventions. 2012. Vol. 80, №4. P. 636-643. doi:10. 1002/ccd.24283

[73] Sarac TP, Hilleman D, Arko FR, et al. Clinical and economic evaluation of the trellis thrombectomy device for arterial occlusions: preliminary analysis. Journal of Vascular Surgery. 2004;39(3):556-9. doi:10.1016/j.jvs.2003.10.061

[74] Sarac T.P., Hilleman D., Arko F.R., et al. Clinical and economic evaluation of the trellis thrombectomy device for arterial occlusions: preliminary analysis // Journal of Vascular Surgery. 2004. Vol. 39, №3. P. 556-559. doi:10.1016/j.jvs.2003.10.061

[75] Darwood R, Berridge DC, Kessel DO, et al. Surgery versus thrombolysis for initial management of acute limb ischaemia. Cochrane Database of Systematic Reviews. 2018;8. doi:10.1002/14651858.CD002784.pub3

[76] Darwood R., Berridge D.C., Kessel D.O., et al. Surgery versus thrombolysis for initial management of acute limb ischaemia // Cochrane Database of Systematic Reviews. 2018. Vol. 8. doi:10.1002/ 14651858.CD002784.pub3

[77] Ouriel K, Shortell CK, DeWeese JA, et al. A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia. Journal of Vascular Surgery. 1994; 19(6):1021-30. doi:10.1016/S0741-5214 (94)70214-4

[78] Ouriel K., Shortell C.K., DeWeese J.A., et al. A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia // Journal of Vascular Surgery. 1994. Vol. 19, №6. P. 1021-1030. doi:10. 1016/S0741-5214 (94)70214-4

[79] Graor RA, Comerota AJ, Douville Y, et al. Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial. Annals of Surgery. 1994;220(3):251-68. doi:10.1097/00000658-19940 9000-00003

[80] Graor R.A., Comerota A.J., Douville Y., et al. Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial // Annals of Surgery. 1994. Vol. 220, №3. P. 251-268. doi:10.1097/ 00000658-199409000-00003

[81] Ouriel K, Veith FJ, Sasahara AA. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. The New England Journal of Medicine. 1998; 338 (16):1105-11. doi:10.1056/NEJM199804163381603

[82] Ouriel K., Veith F.J., Sasahara A.A. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs // The New England Journal of Medicine. 1998. Vol. 338, №16. P. 1105-1111. doi:10.1056/ NEJM199804163381603

RIGHTS & PERMISSIONS

Kutsko E.A.