LAUSR

Objectives: This preliminary study examined the technical efficacy and safety of treating acute limb occlusion after EVAR with pharmacomechanical thrombectomy (PMT) using the AngioJet rheolytic system. Methods: The technical aspects, success, and complications of the first seven consecutive patients presenting with acute limb occlusion after EVAR treated with PMT were analyzed. All patients underwent surgical femoral exposure to facilitate distal arterial control and limit distal embolization. Completion thrombectomy angiograms were reviewed to identify anatomical or structural causes for limb occlusion and subsequently treated accordingly. Technical success, distal embolization, major hemorrhagic complications, acute kidney injury, compartment syndrome, 30-day patency, and amputation-free survival were evaluated. Results: Six of seven patients (86%) presented with acute limb occlusion within 30 days of the original EVAR procedure. All patients were on antiplatelet therapy at time of presentation. Narrowing or kinking of the endograft limb was apparent on computed tomography scan in three patients (43%). An embolic etiology of limb occlusion was suspected in two patients (29%). The technical success rate with PMT treatment was 100%. All patients subsequently underwent EVAR limb stenting in the same procedure. There were no reported cases of distal embolization after PMT or major hemorrhagic complications. Two patients (29%) developed compartment syndrome after revascularization requiring lower leg fasciotomies. Furthermore, two patients (29%) developed acute kidney injury during their hospital admission. The 30-day patency and amputation-free survival rate for PMT was 100%. The overall mean length of stay in hospital for PMT treatment was 9.8 6 4.2 days. Conclusions: Early results of PMT with the AngioJet system represent a novel strategy for treating acute limb occlusion after EVAR that is safe and effective.