The Safety and Efficiency of Endovascular Treatment of Acute or Subacute Thromboembolic Occlusions of Lower Extremity.

First People's Hospital of Hangzhou400 enrolled

Overview

Based on the development of new tools, including drug coated balloon, paclitaxel eluting stent, interwoven stents, debulking tools, More and more acute or subacute thromboembolic occlusions of lower extremity included stage IIb were treated with endovascular procedures. Most guidelines suggests only stage I and stage IIa lesions are suitable for endovascular treatments. Therefore, a well-designed real-world study that track the safety and clinical relevant outcomes, are required to determine the optimal therapies for patients with acute or subacute thromboembolic occlusions of lower extremity.

According to the Trans-Atlantic Inter-Society Consensus (TASC) II guidelines, acute arterial occlusion which in stage IIb was recommended for thrombectomy. However, with the development of new tools, including drug coated balloon, paclitaxel eluting stent, interwoven stents, debulking tools, stage IIb patients and some subacute thromboembolic lesions were also effective in some retrospective studies. Despite The shift of Endovascular-first strategy has been documented in recent literature. There still lack evidence to support either approach have a significant advantage over the thrombectomy. And stage IIb lesions and subacute lesions are often excluded in prospective clinical trials. Therefore, a well-designed real-world study that track the safety and clinical relevant outcomes, are required to determine the optimal therapies for patients with acute or subacute thromboembolic occlusions of lower extremity.

Study Type

OBSERVATIONAL

Enrollment

400

Conditions

Thromboembolic Disease Lower Extremity Problem Endovascular Treatment

Interventions

endovascular treatmentPROCEDURE

All the patients are treated by endovascular therapy, through contralateral femoral artery approach, ipsilateral antegrade femoral artery approach or brachial artery approach. If the lesion is difficult to pass in antegrade approach, retrograde puncture at the distal artery of the lesion can be performed. Surgeons can choose treatment methods such as pharmacomechanical thrombectomy (PMT) and mechanical thrombectomy device (MTD) and/or pharmacomechanical thrombectomy (PMT）and/or percutaneous aspiration thrombectom (PAT) and/or CDT(catheter-directed thrombolysis) and/or percutaneous aspiration thrombectom (PAT) thrombolysis (CDT) for thrombus removal according to the characteristics of the lesions and hospital conditions.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion criteria 1. Patients aged 18 years or older. 2. Diagnosis of acute or subacute limb ischemia classified as Rutherford classification stage I to IIb. 3. Rutherford classification ranging from 3 to 5. 4. Successful guidewire passage through the lesion of the femoropopliteal artery lesion, followed by further endovascular treatment. There are no restrictions will be implemented on the methods used for guidewire passage through the target lesion. The presence of thrombus must be confirmed via angiography and/or DSA and must be associated with occlusions of the lower extremity or ISR. 5. Mechanical thrombectomy device (MTD) and/or pharmacomechanical thrombectomy (PMT) and/or percutaneous aspiration thrombectomy(PAT) and/or CDT (catheter-directed thrombolysis) performed for thrombus removal. 6. The lower extremity artery must have a healthy runoff of at least 10 cm above the ankle with at least one healthy dorsalis pedis artery, medial plantar artery, or lateral plantar artery connecting to the digital artery below the ankle. 7. Informed consent signed by patients. Exclusion criteria 1. Acute or subacute limb ischemia patients with Rutherford classification stage III. 2. Patients diagnosed with thromboangiitis obliterans. 3. Patients requring open surgery or hybrid operation after contrast radiography. 4. Patients with a history of stroke, cerebral hemorrhage, gastrointestinal bleeding, myocardial infarction, or similar conditions in the past 3 months. 5. Patients with known allergies to heparin, low molecular weight heparin, or contrast agents. 6. Patients at high risk for bleeding. 7. Pregnant or lactating women. 8. Patients with other conditions that may complicate study participation or significantly reduce life expectancy (\< 2 years), such as tumors, severe liver disease, and cardiac insufficiency. 9. Patients enrolled in other clinical studies within the past 3 months. 10. Patients unwilling or refusing to sign the informed consent form. \-

Outcomes

Primary Outcomes

Amputation-free survival

The amputation-free survival after endovascular surgery

Time frame: post-interventional 12months

Adverse events at post-interventional 1months

the incidence of amputation, operation-related distal embolism, rethrombosis, acute renal failure and/or death.

Time frame: post-interventional 1 months

Secondary Outcomes

Technical success rate

Time frame: Post operation up to 1 day

Clinical-driven Target lesion reintervention(CD-TLR) rate

Clinical-driven Target lesion reintervention rate

Time frame: post-interventional 12 months

Clinical-driven Target vascular reintervention(CD-TVR) rate

Clinical-driven Target vascular reintervention rate

Time frame: post-interventional 12 months

The total time used in the operation

Time frame: Intraoperative

Primary patency(PP)of the lesions

Time frame: post-interventional 12 months

Changes of quality of life assessed by VascuQol scale

Changes of quality of life

Time frame: post-interventional 12 months

Direct medical expenses (2-year cumulative hospitalization expenses and endovascular expenses related to target lesions)

Direct medical expenses

Time frame: 2 years

The Safety and Efficiency of Endovascular Treatment of Acute or Subacute Thromboembolic Occlusions of Lower Extremity.

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts