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Comparative Analysis Of Open Versus Percutaneous Thrombectomy In Acute Limb Ischemia: Outcomes Of Mortality And Limb Salvage At 30 Days And 1 Year
Mohammad Alsarayreh, MBBS, Katherine G. Welch-Mabon, B.S., Chris Agala, PhD, Mark A. Farber, MD, Katherine McGinigle, MD, MPH, Federico E. Parodi, Md, Ehsan Benrashid, MD, Luigi Pascarella, MD.
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
OBJECTIVES:Acute limb ischemia (ALI) is associated with significant morbidity and mortality. The optimal approach for thrombectomy, whether open or percutaneous, remains debated. This study aims to compare these two modalities regarding mortality rates and limb salvage outcomes at 30 days and 1 year.
METHODS: We reviewed consecutive patients with ALI treated with PT or OT between 2018 and 2023 at a single institution. Patients with iatrogenic or trauma-induced ALI were excluded. Primary outcomes were survival and limb loss rates at 30 days and 1 year. Secondary outcomes included thrombolysis, fasciotomy, stent use, and reintervention rates. Categorical variables were analyzed using Fisher’s exact and Chi-square tests, while Wilcoxon Two-Sample test was applied for continuous variables. Kaplan-Meier and Cox Proportional Hazards models were used to assess time-to-event outcomes and risk factors for survival. Logistic regression assessed odds of major amputation.
RESULTS:Among 245 patients, 182 limbs (163 patients) underwent OT, and 84 limbs (82 patients) underwent PT (89% using the Penumbra system). The cohort was 52.2% male, with a mean age of 64.3±14.6 years. Most limbs (80%) were Rutherford classification II (IIa: 104, IIb: 107). PT patients had higher rates of hypertension (P=0.035), prior lower extremity interventions (P=0.0005), and acute-on-chronic ischemia (P=0.024). PT was preferred in patients with Rutherford I or IIa, while OT was more common for IIb cases (P=0.0011). OT cases more frequently involved native artery occlusions, while PT cases involved previous stents or bypasses (P=0.02). Thrombolysis and stent use were higher in PT (P=0.0001 and P=0.001, respectively), while fasciotomy was more frequent in OT (P=0.0001). PT patients had higher reintervention rates at 30 days (P=0.038) and 1 year (P=0.036), with more repeat PTs (P=0.016), while OT patients more frequently required repeat OT (P=0.0005). Major amputation rates did not differ significantly between groups. Survival was higher in the PT group at both time points (P=0.0004 and P=0.0003, respectively).
CONCLUSIONS: Percutaneous thrombectomy demonstrated higher survival and reintervention rates at 30-day and 1-year, with similar limb salvage outcomes. Percutaneous thrombectomy should be considered an effective revascularization approach in patients with acute lower extremity limb ischemia when possible.
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