Gegenüberstellung der operativen Thrombembolektomie zur endovaskulären Therapie bei der akuten Beinischämie

Objectives: In acute limb ischemia (ALI) endovascular (ER) and open surgical (OR) procedures are present options for the treatment. There currently is a small number of randomized controlled studies (RCT) which compare the ER and the OR approach. However, a universal recommendation for a first-choice treatment is still missing. Our objective was to analyse recent ER and OR approaches to improve the treatment of ALI. Methods: In a retrospective study, we analysed the data of all patients who were treated for ALI at the university hospital Gießen and Marburg GmbH in Marburg between 2012 and 2013. The primary endpoint was the 1-year limb salvation. Secondary outcomes included 30-days, 1-year and overall mortality, adverse events, reintervention rate and time to reintervention in the ER and OR group. We performed a uni- and multivariate Analysis of the data including a Cox-regression model analysis of the femoral and popliteal subgroups. Results: In our retrospective study included overall 124 patients. 56 were treated endovascularly and 58 received open surgical treatment. The OR group was significantly older (ER 67.9 vs. 75.2 years, p < 0.01). The 1-year limb salvation was 58.9% (ER) vs. 45.6% (OR) (p = 0,139). The 30-days mortality was 27.9% (OR) vs. 10.7% (ER) (p = 0.0173), the 1-year mortality was 51.5% (OR) vs. 16.1% (ER) (p < 0,001) and the overall mortality was 52.9% (OR) vs. 19.6% (ER) (p < 0.001). The overall amputation rate was 14.7% (OR) vs. 41.1%(ER) (p = 0,01). The Cox-regression data did not show any significant difference in the one-year limb salvation between the ER and OR approach (45.7% OR vs. 56.7% ER, p = 0,412). The median number of reinterventions performed in the OR was 4.00 (±3.44SD) vs. 4.67 in the ER (±3.02SD) (p = 0,458). The median time to reintervention was significantly shorter in the ER 114.29 ± 242.66d compared to. 226.91 ± 306.35d vs. in the OR (p = 0.028). Conclusion: Our data analysis has shown that there is no difference in 1-year limb salvation between the endovascular or open surgical approach regarding the treatment of ALI. However, mortality is significantly higher in OR revascularisation. More than 50% of the patients had died after a period of one year. In contrast, a higher overall amputation rate (major and minor amputation) was found among ER treated patients. Additionally, the regression model has shown that the interval for reintervention is significantly shorter in ER. Endovascular and open surgical treatment are effective revascularization options to save the threatened limb. Nevertheless, high overall mortality may be explained due to age structure and multimorbidity. Consequently, future research and treatment should focus on preventive measures and standardized long-term follow-up in a centralized registry.