Routine Versus Selective Use of Intraoperative Angiography During Thromboembolectomy for Acute Lower Limb Ischemia: Analysis of Outcomes

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

“…There is consensus to recommend completion angiography after thrombo-embolectomy to document the outcome, as residual thrombus is common and its identification is associated with a reduced risk of re-intervention and limb loss. 73,79 If residual thrombus is found after embolectomy, further embolectomy or bypass may be considered. A widely used alternative is intra-operative instillation of thrombolytic agents (e.g., recombinant tissue plasminogen activator [rtPA] 4 e 10 mg) directly into the artery downstream with the aim of dissolving residual thrombus.…”

“…Another study evaluated 380 patients with ALI of the leg and found that those who had intraoperative angiography after embolectomy had a higher rate of intra-operative re-intervention, a higher rate of additional interventions due to residual stenosis / occlusion and a lower rate of re-occlusion after 24 months. 79…”

Therapeutic effect of liposomal prostaglandin E1 in acute lower limb ischemia as an adjuvant to hybrid procedures

“…Bosma and Jörning identified using angiography that following thromboembolectomy, 30% of patients presented incomplete clearance of the arterial tree, resulting in a requirement for further embolectomy, as well as a reduced rate of amputation (17). In another study, the adoption of routine intraoperative angiography following thromboembolectomy confirmed that 53.4% patients required intraoperative re-interventions for residual lesions with the result that 2-year primary patency rates were improved (18). Through intraoperative angiography, we identified a residual thrombus in 30.4% of patients, and 35.3% patients required additional solutions (repeated thromboembolectomy and/or endovascular interventions).…”

Aktueller Forschungsstand zur akuten Extremitätenischämie

“…Insbesondere bei Bypassverschlüssen kann so die Ursache des Verschlusses erkannt und sofort endovaskulär behoben werden. Insbesondere sollten beide Anastomosen dargestellt werden, um eventuelle Stenosen nicht zu über-sehen [10]. Die 30-Tage-Amputationsrate nach einer offen-chirurgischen Therapie liegt bei 5-16 %, die 30-Tage-Mortalität bei 9-22 %, die 5-Jahres-Beinerhaltungsrate bei 61-81 % und die 5-Jahres-Überlebens-rate bei 33-43 % [14][15][16][17][18][19][20].…”