Background: Acute lower limb ischemia (ALI) caused by arterial embolism, thrombosis of native vessels, and/or grafts is a serious condition associated with substantial morbidity and mortality. Peripheral arterial thrombolysis utilizing catheter-directed thrombolytic (CDT) has become established as a useful option in the management of ALI. However, use and outcome of adjunctive power pulse spray with rheolytic thrombectomy (PPSRT) following unsuccessful CDT is underreported in the literature.

Purpose: To evaluate outcome of contemporary use of intra-arterial CDT PPSRT as an adjunct to unsuccessful standard CDT for ALI.

Methods: We reviewed 78 consecutive patients (mean age 69 ± 14.2 years, 48.8% female) who presented to Aurora St. Luke’s Medical Center with less than 14 days of ALI from January 2004 to October 2014. All patients had percutaneous transluminal angioplasty procedures as a standard revascularization option for ALI. Data were collected from electronic medical records, and billing codes. Continuous variables were expressed as mean ± standard deviation and range, and categorical variables as frequency count and percentage. Differences between the groups were analyzed with t-tests or analysis of variance and chi-square or Fisher’s test.

Results: 48 patients (Group 1) underwent CDT alone with successful technical and clinical results, while 30 patients (Group 2) who had unsuccessful CDT results underwent adjunctive CDT with PPSRT. There was no statistical significance among both groups in regard to their baseline characteristics. In Group 1 and Group 2, respectively, limb salvage was 87.5% and 86.6% (P=ns), amputation at 30 days 13% and 16% (P=ns), embolectomy 16.67% and 20% (P=ns), emergent bypass graft 8.3% and 13.33% (P=ns), distal embolization 14.89% and 17.24% (P=ns), 30-day compartmental syndrome 12.5% and 13.79% (P=ns), death at 30 days 8.8% and 13.33% (P=ns), and bleeding requiring blood transfusion 16% and 14% (P=ns). Hemorrhagic stroke occurred in one patient of Group 1. Complete and partial analysis achieved in (Group 2) 73.4%, length of hospitalization was 10.6 ± 6.25 days (P=ns).

Conclusion: Adding intra-arterial CDT power pulse spray with rheolytic thrombectomy to unsuccessful standard CDT as an adjunctive procedure is a powerful revascularization tool for lower extremity acute limb ischemia that achieves success in the vast majority of patients, is not associated with higher complications when compared to successful CDT alone, and obviates the need for emergent surgical revascularization.