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Pedal Cutdown vs. Open Proximal Thrombectomy for Lower Extremity Embolism: Less is More
Ruosu An, MD, Matthew R. Smeds, MD, Mohammed M. Moursi, MD, Guillermo A. Escobar, MD, Ahsan T. Ali, MD.
University of Arkansas for Medical Sciences, Little Rock, AR, USA.
OBJECTIVES:
Acute limb ischemia from thrombo-embolism can lead to significant morbidity, even limb loss. Pedal cut-down (PC) at the ankle has been used as a desperate attempt for limb salvage. We hypothesize that thrombecotmy via a more proximal cut-down at the below the knee trifurcation (TC) level would result in higher patency and limb salvage.
METHODS:
A retrospective review was undertaken at a tertiary care center from 2004-2014 for all patients with acute limb ischemia (ALI) due to embolism. Patients with chronic occlusive disease, ischemia from trauma, and occluded bypass grafts were excluded. Likewise, patients with advanced ischemia and/or insensate foot were not included.
RESULTS:
Out of 68 patients, the majority were men (78%). All patients presented with profound ischemia with no recordable toe pressure or Doppler signal in the foot. Mean Age was 64.3±7.4 yr. More than half of the patients, 56% (38/68) underwent pedal cut-down at the ankle level. In the proximal cut down (TC) group, 44% (30/68) underwent catheter directed thrombo-embolectomy from the popliteal artery. Medical comorbidities and ASA class were similar in each group. Amputation rate for PC group was 34% (13/38) and was significantly higher than the TC group 10% (3/30) (p<0.05)
CONCLUSIONS:
Proximal cut down, with catheter directed thrombectomy, had a lower amputation rate when compared to pedal cut-down at ankle and is the preferred method for treatment of acute embolism to the foot.
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