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Acute lower limb ischemia (ALI) remains a challenging vascular emergency with high amputation rates of up to 40% and mortality rates reaching 15-20%. Recent advancements in endovascular treatment strategies have shown promising results compared to open surgery, but no comparative studies to a standalone lysis regimen exist. We analyzed the outcomes of patients treated first with pharmacomechanical thrombectomy with the AngioJet™ system (Boston Scientific, Marlborough, MA, USA) versus patients that underwent primary lysis and present our findings.

This was a retrospective, single-center observational study of all consecutive patients undergoing primary AngioJet™ thrombectomy with or without lysis and primary lysis without thrombectomy for the treatment of ALI. The primary endpoint of the study was technical success, defined as successful recanalization and less than 30% residual thrombus on the final angiography. Secondary endpoints included mortality, major amputation and reintervention.

Between January 2014 and January 2024, 88 patients were treated for ALI using either primary AngioJet™ or primary lysis (69.3% males; mean age 71 ± 14 years). Rutherford class I ischemia was the initial presentation in 37.5% of patients, class IIa in 35.2%, class IIb in 18.2% and class III in 5.7%. Primary lysis was the treatment of choice in 39.8% of cases and primary AngioJet in 60.2%. A stent or stentgraft occlusion was observed in 9 cases (9.2%) and a bypass occlusion in 27 cases (30.7%), with the rest of the occlusions occurring in native vessels. Primary lysis was used more frequently than AngioJet™ when the tibial vessels were involved (42.9% vs. 17%, p= .013). Technical success was significantly higher in the AngioJet™ group (94.3% vs. 57.1%, p < .001). After a median follow-up of 10 months (range 0-130 months, IQR 11.5 months) significantly more reinterventions were needed in the primary lysis group than in patients that underwent AngioJet™ thrombectomy (40% vs. 13.2%, p= .005). Mortality and major amputation rates did not differ significantly between the groups.

Out results indicate significantly higher technical success after primary AngioJet™ thrombectomy with or without lysis than in patients undergoing a primary lysis treatment. Moreover, significantly less reinterventions were needed over the follow-up period in patients undergoing primary AngioJet™ thrombectomy.