Hybrid Techniques versus Thrombolysis Associated with Completion Angioplasty in Treatment of Acute on Top of Chronic Lower Limb Ischemia.

Abstract

Introduction: Acute on top of chronic ischemia, is an acute dramatic deterioration of symptoms in a chronicperipheral arterial disease (PAD) patient. The clinical presentation may be less pronounced compared to patientswith pure acute embolic occlusion. Catheter directed thrombolysis (CDT) has been added to the armamentariumof treatment for acute limb ischaemia since the STILE and TOPAS trials. Hybrid techniques for treating acute limbischemia, usually at different levels, are done by combining both open surgical and endovascular techniques.Patients and methods: A retrospective 2 arm comparative study was conducted on patients presented with limbthreatening ischemia over the course of 18 months between September 2022 to March 2024 by comparing hybridthrombectomy followed by completion angioplasty to catheter directed thrombolysis (CDT) followed by completionangioplasty regarding limb salvage, complication rates and patency.Results: A total 53 patients were divided into 2 groups. The primary outcome was the technical success thatwas achieved in 21 cases (91.3%) in hybrid group compared to 23 cases (76.7%) in CDT group. The secondaryoutcome was the limb salvage that was obtained in 21 cases (91.3%) in hybrid group and in 23 (76.7%) in CDTgroup. Procedure related adverse events were mostly in the CDT group as distal embolization (3 cases). Bothgroups had equal 30 days mortality 3 patients.Conclusion: Although the total endovascular approach shows a slightly higher incidence of distal embolizationand bleeding complications compared to the hybrid approach, both approaches demonstrate comparable rates oflimb salvage in correlation with the stage of acute ischemia.