Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI.
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT.
J Vasc Surg. 2024 Nov;80(5):1569-1577.e0. doi: 10.1016/j.jvs.2024.07.004. Epub 2024 Jul 6.
Acute limb ischemia (ALI) remains a vascular emergency with high morbidity and mortality. While the JETi Hydrodynamic Thrombectomy System (Abbott) offers a percutaneous approach to fragment and aspirate the thrombus in patients with arterial occlusions, data on its efficacy and safety are limited. This study reports our early experience using the JETi device to treat ALI at our institution.
This is a single-center, retrospective review of patients with ALI treated with the JETi device between September 2020 and December 2022. Patients were included if the JETi device was used either as a primary intervention or as an adjunct procedure. The primary endpoint was technical success defined as <50% residual thrombus after intervention. Secondary endpoints included achieving complete resolution of the thrombus on angiogram, acute kidney injury (AKI), major bleeding, 30-day major amputation, and 30-day mortality.
A total of 59 JETi procedures for ALI (median age 62 years [interquartile range: 56-71 years]) were performed on 39 male and 20 female patients. The median time from onset of symptoms to hospitalization was 24 hours (interquartile range: 4-168 hours). Rutherford classifications were I (10), IIa (27), IIb (14), and undocumented (8). Etiology of ALI was native vessel thrombosis (27), embolism (16), graft/stent thrombosis (14), and iatrogenic (2). A total of 124 vessels were treated, with an average of 2.1 vessels per procedure. The primary outcome was achieved in 86% (107/124) of the arteries, with 82% (102/124) successfully opened using the JETi device alone without the need for any adjunctive therapy. Complete resolution of the thrombus using JETi was achieved in 81% (101/124) arteries, with or without the use of adjunctive therapy. A total of 6.7% (4/59) patients required a major limb amputation within 30 days despite successful recanalization, and one 30-day mortality was recorded. Complications included distal embolization (5), access site hematoma (2), and AKI (4). No major bleeding, hemolysis-induced AKI, or vessel dissection or perforation was observed.
The JETi device appears to be a safe and effective percutaneous treatment option in the management of ALI. It provides definitive treatment with a high technical success rate of 86% and a good safety profile.
急性肢体缺血（ALI）仍然是一种高发病率和死亡率的血管急症。虽然 JETi 动力血栓切除术系统（雅培）为动脉闭塞患者提供了一种经皮方法来碎裂和抽吸血栓，但关于其疗效和安全性的数据有限。本研究报告了我们在机构中使用 JETi 设备治疗 ALI 的早期经验。
这是一项单中心、回顾性研究，纳入了 2020 年 9 月至 2022 年 12 月期间使用 JETi 设备治疗的 ALI 患者。如果 JETi 设备被用作主要干预措施或辅助治疗，患者将被纳入研究。主要终点定义为干预后残余血栓<50%。次要终点包括血管造影显示血栓完全溶解、急性肾损伤（AKI）、大出血、30 天内主要截肢和 30 天内死亡率。
共对 39 名男性和 20 名女性患者的 59 例 ALI 进行了 59 次 JETi 手术，中位年龄为 62 岁（四分位距：56-71 岁）。从症状发作到住院的中位时间为 24 小时（四分位距：4-168 小时）。Rutherford 分类为 I（10）、IIa（27）、IIb（14）和未记录（8）。ALI 的病因是原发性血管血栓形成（27）、栓塞（16）、移植物/支架血栓形成（14）和医源性（2）。共治疗 124 条血管，平均每条血管治疗 2.1 次。主要结局在 86%（107/124）的动脉中达到，其中 82%（102/124）仅使用 JETi 设备成功开通，无需任何辅助治疗。使用 JETi 成功溶解血栓的比例为 81%（101/124），无论是否使用辅助治疗。尽管成功再通，但仍有 6.7%（4/59）的患者在 30 天内需要进行主要截肢，1 例患者在 30 天内死亡。并发症包括远端栓塞（5）、入路部位血肿（2）和 AKI（4）。未观察到大出血、溶血引起的 AKI、血管夹层或穿孔。
JETi 设备似乎是一种安全有效的治疗 ALI 的经皮治疗选择。它提供了明确的治疗，技术成功率高，达 86%，安全性良好。
