To report the outcomes in terms of death and major limb events (defined as major amputation or reintervention) for patients who underwent endovascular pharmacomechanical thrombectomy (AngioJet, Boston) for acute limb ischemia (ALI).

This is a retrospective observational single center cohort study of all patients with ALI who underwent endovascular PMT at our center between January 2013 and December 2020. Medical history, surgical data and 12 months follow-up were collected from our local database. The primary endpoint was death at 12 months. Secondary endpoints were major amputation and reintervention at 12 months, as well as general and surgical complications at 30 days. Univariate and multivariate analysis were performed for a composite of major limb events and death at 12 months.

During the study period, 151 patients were included in our cohort. Mean age was 70.7 +/- 12.8 years and 64.2% were male. 86 patients (57.7%) presented a Rutherford stage 1 ALI, 37 (24.5%) had a stage 2a and 27 (17.8%) had a stage 2b. Most occlusions were thrombotic (85.4%) and occurred at the lower limb level (82.8%). 95 patients (63%) had a history peripheral revascularization. Mean intervention time was 137 +/- 76.2 minutes and procedural technical success was achieved in 128 patients (85%). 113 (74.8%) had concomitant angioplasty, and 93 (61.6%) had stent implantation. Mean contrast media dose used was 90 +/- 50.6 ml. At 30 days, general complications occurred in 24 patients (15.9%) (1 myocardial infarction, 19 acute renal failures, and 4 pneumonias) and surgical complications in 23 patients (15.2%) (4 wound infections, 14 hematomas, 1 compartment syndrome and 4 pseudoaneurysms). Mean hospital stay was 11.7 +/- 15.3 days, 50 patients (33%) were discharged home. Mortality rate was 7.2% at 30 days and 15.9% at 1 year. At 1-year, major amputation and reintervention rates were respectively 9.3% and 30%. Univariate analysis showed that length of stay was the only factor associated with a highest rate of a composite of major limb event and death at 1 year (OR 1.08, 1.03-1.13, p <0.001).

Acute limb ischemia is associated with a high risk of death, reintervention and major amputation. PMT provides a rapid reperfusion of the limb with satisfying rate of limb salvage.