161 - Aspiration Thrombectomy versus Pharmacologic Thrombolysis for Acute Limb Ischemia: A Single-Center Retrospective Review

Monday, April 13, 2026

3:18 PM - 3:27 PM ET

Presenting Author(s)

Joshua Baker, DO

Research Associate
Baptist Health South Florida - Miami Cardiac and Vascular Institute, United States

Author/Co-author(s)

PS

Parnavi Singh

Medical Student
Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, United States
ST

Sergio Torralbas, MS

Research Associate
Miami Cardiac and Vascular Institute, United States
DH

David Harbaugh, BS

Medical student
Florida International University Herbert Wertheim College of Medicine, United States
VH

Varun Hariharan, BS

Medical student
Florida International University Herbert Wertheim College of Medicine, United States
SL

Sebastian Leal, BS

Medical student
Florida International University Herbert Wertheim College of Medicine, United States
EP

Emery Perrin, BS

Medical student
Florida International University Herbert Wertheim College of Medicine, United States
BK

Barry T. Katzen, MD, FSIR

Founder and Chief Medical Executive
Miami Cardiac and Vascular Institute, United States
RH

Raul Herrera, MD

Director, Research and Outcomes
Miami Cardiac and Vascular Institute, United States
Alex Powell, MD, FSIR

Attending Physician
MCVI, United States
Ripal Gandhi, MD, FSIR

Professor
Miami Cardiac & Vascular Institute, Miami Cancer Institute, United States
Adam Geronemus, MD, FSIR

Vascular & Interventional Radiology
Miami Cardiac and Vascular Institute, United States
RM

Ronald Mora, MD

Interventional Radiologist
Miami Cardiac and Vascular Institute, United States
Constantino Pena, MD

Interventional Radiologist
Miami Cardiac & Vascular Institute, United States
Brian J. Schiro, MD

Vascular and Interventional Radiologist
Miami Cardiac & Vascular Institute / Radiology Associates of South Florida, United States

Purpose: This single-center, retrospective study aimed to evaluate and compare outcomes of aspiration thrombectomy and pharmacologic thrombolysis in patients with acute limb ischemia (ALI).

Materials and Methods: A total of 303 patient records who presented with ALI from 2016 to 2024 were reviewed. Those who were treated with aspiration thrombectomy (n = 58) or pharmacologic thrombolysis (n = 65) were included. Those treated with multiple primary interventions or other forms of mechanical thrombectomy were excluded. Primary endpoints include technical success, procedural success, primary patency and amputation free survival. Secondary endpoints include in-hospital complications, major amputation and mortality.

Results: Notable differences in demographic variables between aspiration thrombectomy and pharmacologic thrombolysis include age (71.83 ± 15.5 vs 66.4 ± 13.4, p = 0.04), male sex (47% vs 69%, p = 0.01), diabetes (60% vs 40%, p = 0.02), pre-existing peripheral arterial disease (47% vs 77%, p = < 0.001), prior cerebrovascular accident (24% vs 8%, p = < 0.001), and smoking history (49% vs 74%, p = 0.01). A greater proportion of those treated with aspiration thrombectomy presented with ALI of embolic or native vessel etiology (92% vs 38%, p = < 0.001) while a greater proportion of those treated with pharmacologic thrombolysis presented with stent or graft occlusion (8% vs 62%, p = < 0.001). The rates of technical success (97% vs 91%, p = 0.19) and procedural success (78% vs 78%, p = 0.92) did not significantly vary between cohorts. Furthermore, 12-month primary patency (77% vs 70%, p = 0.46) and amputation free survival (94% vs 93%, p = 0.71) did not vary significantly between cohorts. Complication rates were low overall with notable differences between cohorts being the occurrence of distal embolization (0% vs 5%, p = 0.06), recurrent thrombus (5% vs 0%, p = 0.02), and reperfusion injury (0% vs 5%, p = 0.06). In-hospital amputation rates were similar (5% vs 6%, p = 1) as was in-hospital mortality of any cause (7% vs 2%, p = 0.19).

Conclusion: Within this cohort, aspiration thrombectomy and pharmacologic thrombolysis obtained similar technical and procedural success and maintained similar 12-month primary patency and amputation free survival rates. Given the greater medical utilization associated with pharmacologic thrombolysis, these findings favor use of aspiration thrombectomy. However, further research is needed to determine if confounding variables such as the suspected etiology of ALI may bias findings given the significant baseline variation between cohorts.