Stent-assisted recanalisation of acute occlusive arteries in patients with acute limb ischaemia

Eur J Vasc Endovasc Surg. 2010 Jan;39(1):89-96. doi: 10.1016/j.ejvs.2009.09.023. Epub 2009 Nov 10.

Abstract

Objective: To assess the efficacy of stent-assisted recanalisation for acute limb ischaemia in patients considered unfit for thrombolysis or in patients with failed surgical recanalisation.

Materials and methods: Fifteen patients with acute limb ischaemia, treated with stent implantation, were analysed retrospectively. The reasons for acute limb ischaemia were a cardiogenic embolism (n=3), a traumatic injury (n=3), acute in situ thrombosis with atherosclerosis (n=6), immediate graft thrombosis (n=2), or a delayed thrombotic occlusion after a thrombin injection in the pseudoaneurysm (n=1). This study examined the technical and clinical outcomes of the procedures, including complications during the procedural and follow-up periods.

Results: Stent-assisted recanalisation was technically successful and provided immediate recanalisation in all patients (15/15 patients, 100%) and reduced or eliminated the clinical symptoms in 12 patients (12/15 patients, 80%). Two patients died of multi-organ failure related to reperfusion injury, and one patient with a crash injury underwent a below-the-knee amputation as a result of wound necrosis despite recanalisation of the occluded bypass graft.

Conclusions: Stent-assisted recanalisation has a high technical success rate with good clinical results as a bailout procedure for the management of acute limb ischaemia in patients, considered unfit for thrombolysis or in patients with failed surgical recanalisation.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Amputation, Surgical
  • Angiography, Digital Subtraction
  • Angioplasty, Balloon / adverse effects
  • Angioplasty, Balloon / instrumentation*
  • Angioplasty, Balloon / mortality
  • Arterial Occlusive Diseases / complications
  • Arterial Occlusive Diseases / diagnosis
  • Arterial Occlusive Diseases / mortality
  • Arterial Occlusive Diseases / physiopathology
  • Arterial Occlusive Diseases / therapy*
  • Female
  • Femoral Artery
  • Graft Occlusion, Vascular / complications
  • Graft Occlusion, Vascular / diagnosis
  • Graft Occlusion, Vascular / mortality
  • Graft Occlusion, Vascular / physiopathology
  • Graft Occlusion, Vascular / therapy*
  • Humans
  • Iliac Artery
  • Ischemia / diagnosis
  • Ischemia / etiology
  • Ischemia / mortality
  • Ischemia / physiopathology
  • Ischemia / therapy*
  • Limb Salvage
  • Lower Extremity / blood supply*
  • Male
  • Middle Aged
  • Popliteal Artery
  • Retrospective Studies
  • Stents*
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Doppler, Duplex
  • Vascular Patency
  • Young Adult