【論文摘要】A Systematic Review on Percutaneous Mechanical Thrombectomy versus Catheter-directed Thrombolysis in Acute Limb Ischemia

Julie Ann Stephanie Miralles ； Joan Dymphna Reano

《海峽循環醫學雜誌》 1卷2S期 (2019/09) Pp. 45-45

https://doi.org/10.6907/SCJ.201909/SP_1(2).0038

摘要

Background/Synopsis: Acute limb ischemia (ALI) can have devastating presentations, but are treatable if recognized early. It is a medical emergency and recognizing this is essential especially for limb viability. Mortality is as high as 18% when amputation rates can be as high as 13%. For cases with threatened limbs, immediate revascularization should be done. Data on revascularization strategies such as percutaneous mechanical thrombectomy (PMT) versus catheter-directed thrombolysis (CDT) have been evaluated. Studies showed that PMT has benefit in the reduction of bleeding. Objectives/Purpose: To determine the association of percutaneous mechanical thrombectomy versus catheter-directed thrombolysis in preventing the development of major adverse limb events (MALE), allcause mortality, bleeding complications, and hospital stay among patients with acute limb ischemia. Methods/Results: Observational studies including patients with acute limb ischemia comparing percutaneous mechanical thrombectomy (PMT) versus catheter-directed thrombolysis (CDT) with outcomes of major adverse limb events (MALE), mortality, and bleeding complications were searched. Results of this systematic review showed that PMT versus CDT showed no significant difference in allcause mortality, reintervention and amputation. PMT had significant benefit in the reduction of bleeding. There were mixed reviews for the duration of hospital stay, such that one study mentioned statistical benefit in the reduction of hospital stay, while the other did not. Conclusion: Percutaneous mechanical thrombectomy offered significant benefit in the reduction of bleeding, and in individual studies showed lesser cost and shorter duration of hospital stay. It was observed that the studies reviewed were limited to retrospective studies and the undersized population. Further studies focusing on larger sample size and randomized control trials are recommended.