Abstract：
OBJECTIVE: The main objective of this present paper was to evaluate the results and outcomes of patients with acute limb ischemia (ALI) submitted to pharmacomechanical thrombectomy (PMT) endovascular surgery with Angiojet, regarding the number of cycles/pumps.
METHODS: Prospective, consecutive cohort study of ALI patients submitted to PMT endovascular intervention subdivided into two groups according to the number of cycles in the Angiojet technique: Group 1 higher than 150 cycles/second and Group 2 lesser than 150 cycles/second (cycles/s).
RESULTS: Overall, 92 patients with ALI submitted to PMT were evaluated. Two groups of patients were identified: Group 1 higher than 150 cycles/s with 60 patients and Group 2 lesser than 150 cycles/s with 32 patients. The overall mortality rate (OMR) was 15.1% (13 patients) in total cohort within the first 30 days. Group 1 had a higher OMR than Group 2 (16.1% vs 9.3%, p = 0.007). There were 4 cases of hematuria (4.3%), all of them in Group 1. We have performed a Kaplan-Meier regarding limb salvage rates: Group 1 had 85% and Group 2 had 95.7% at 1057 days. P = 0.081. Among the factors evaluated, the following were related to overall mortality rate: PMT with higher >150 cycles/s (HR = 7.17, p = 0.007, CI: 1.38-8.89), COVID-19 infection (HR = 2.75, p = 0.010, CI = 1.73-5.97), and post-operative acute kidney injury (HR = 2.97, p < 0.001, CI = 1.32-8.13). Among the factors evaluated, the following was related to limb loss: post-operative acute kidney injury (HR = 4.41, p = 0.036, CI: 1.771-7.132), probably because patients experiencing limb loss have a higher incidence of acute renal insufficiency due to higher circulating myoglobin higher hemolysis from the increased Angiojet cycles inducing rhabdomyolysis.
CONCLUSIONS: PMT with Angiojet is a safe and effective therapy in patients with ALI. However, patients receiving greater than 150 cycles/s were noted to have higher rates of acute kidney injury and mortality. This is likely reflective of increased thrombus burden and higher rates of hemolysis. Acute kidney injury, greater than 150 cycles/s, and COVID-19 infection were the variables with the strongest association to perioperative mortality.
METHODS: Prospective, consecutive cohort study of ALI patients submitted to PMT endovascular intervention subdivided into two groups according to the number of cycles in the Angiojet technique: Group 1 higher than 150 cycles/second and Group 2 lesser than 150 cycles/second (cycles/s).
RESULTS: Overall, 92 patients with ALI submitted to PMT were evaluated. Two groups of patients were identified: Group 1 higher than 150 cycles/s with 60 patients and Group 2 lesser than 150 cycles/s with 32 patients. The overall mortality rate (OMR) was 15.1% (13 patients) in total cohort within the first 30 days. Group 1 had a higher OMR than Group 2 (16.1% vs 9.3%, p = 0.007). There were 4 cases of hematuria (4.3%), all of them in Group 1. We have performed a Kaplan-Meier regarding limb salvage rates: Group 1 had 85% and Group 2 had 95.7% at 1057 days. P = 0.081. Among the factors evaluated, the following were related to overall mortality rate: PMT with higher >150 cycles/s (HR = 7.17, p = 0.007, CI: 1.38-8.89), COVID-19 infection (HR = 2.75, p = 0.010, CI = 1.73-5.97), and post-operative acute kidney injury (HR = 2.97, p < 0.001, CI = 1.32-8.13). Among the factors evaluated, the following was related to limb loss: post-operative acute kidney injury (HR = 4.41, p = 0.036, CI: 1.771-7.132), probably because patients experiencing limb loss have a higher incidence of acute renal insufficiency due to higher circulating myoglobin higher hemolysis from the increased Angiojet cycles inducing rhabdomyolysis.
CONCLUSIONS: PMT with Angiojet is a safe and effective therapy in patients with ALI. However, patients receiving greater than 150 cycles/s were noted to have higher rates of acute kidney injury and mortality. This is likely reflective of increased thrombus burden and higher rates of hemolysis. Acute kidney injury, greater than 150 cycles/s, and COVID-19 infection were the variables with the strongest association to perioperative mortality.
摘要：
目的：本文的主要目的是评估接受血管喷射药物机械血栓切除术（PMT）血管内手术的急性肢体缺血（ALI）患者的结果和结局，关于循环/泵的数量。
方法：前瞻性，接受PMT血管内介入治疗的ALI患者的连续队列研究根据Angiojet技术的周期数分为两组:第1组高于150周期/秒,第2组低于150周期/秒(周期/秒).
结果：总体而言，对92例接受PMT治疗的ALI患者进行了评估。确定了两组患者：第1组高于150周期/秒，有60例患者，第2组低于150周期/秒，有32例患者。在前30天的总队列中，总死亡率（OMR）为15.1%（13名患者）。第1组的OMR高于第2组(16.1%对9.3%，p=0.007)。血尿4例(4.3%),他们都在第1组。我们对保肢率进行了Kaplan-Meier：第1组有85％，第2组有95.7％在1057天。P=0.081。在评估的因素中，以下与总死亡率相关：PMT高于150个周期/s（HR=7.17，p=0.007，CI：1.38-8.89），COVID-19感染（HR=2.75，p=0.010，CI=1.73-5.97），和术后急性肾损伤（HR=2.97，p<0.001，CI=1.32-8.13）。在评估的因素中，以下与肢体丢失有关：术后急性肾损伤（HR=4.41，p=0.036，CI：1.771-7.132），可能是因为患肢丢失的患者由于循环肌红蛋白较高而导致急性肾功能不全的发生率较高，血管喷射周期增加导致横纹肌溶解的溶血也较高。
结论：PMT联合Angiojet治疗ALI是一种安全有效的治疗方法。然而,研究发现,接受超过150个周期/s的患者急性肾损伤和死亡率较高.这可能反映了增加的血栓负担和更高的溶血率。急性肾损伤,大于150次/秒，和COVID-19感染是与围手术期死亡率相关性最强的变量。
方法：前瞻性，接受PMT血管内介入治疗的ALI患者的连续队列研究根据Angiojet技术的周期数分为两组:第1组高于150周期/秒,第2组低于150周期/秒(周期/秒).
结果：总体而言，对92例接受PMT治疗的ALI患者进行了评估。确定了两组患者：第1组高于150周期/秒，有60例患者，第2组低于150周期/秒，有32例患者。在前30天的总队列中，总死亡率（OMR）为15.1%（13名患者）。第1组的OMR高于第2组(16.1%对9.3%，p=0.007)。血尿4例(4.3%),他们都在第1组。我们对保肢率进行了Kaplan-Meier：第1组有85％，第2组有95.7％在1057天。P=0.081。在评估的因素中，以下与总死亡率相关：PMT高于150个周期/s（HR=7.17，p=0.007，CI：1.38-8.89），COVID-19感染（HR=2.75，p=0.010，CI=1.73-5.97），和术后急性肾损伤（HR=2.97，p<0.001，CI=1.32-8.13）。在评估的因素中，以下与肢体丢失有关：术后急性肾损伤（HR=4.41，p=0.036，CI：1.771-7.132），可能是因为患肢丢失的患者由于循环肌红蛋白较高而导致急性肾功能不全的发生率较高，血管喷射周期增加导致横纹肌溶解的溶血也较高。
结论：PMT联合Angiojet治疗ALI是一种安全有效的治疗方法。然而,研究发现,接受超过150个周期/s的患者急性肾损伤和死亡率较高.这可能反映了增加的血栓负担和更高的溶血率。急性肾损伤,大于150次/秒，和COVID-19感染是与围手术期死亡率相关性最强的变量。
