Purnama Satria Bakti, Nyityasmono Tri Nugroho, Dedy Pratama
Introduction: Acute limb ischemia (ALI) is characterized by decreased perfusion to extremities in the form of acute ischemia and the presence of acute thrombus which may endanger the viability of the extremities. Therapeutic modalities are various including intraarterial thrombolysis with or without the help of ultrasonography and the use of thrombectomy instruments. However, due to the high morbidity and mortality rate, a new technique called the hybrid procedure is introduced. This procedure is a combination between endovascular management to correct the abnormalities with the help of angiography as well as thrombectomy surgical management, in the same time. Therefore, it is necessary to conduct a literature search related to the case we are reporting, to determine whether hybrid procedure or thrombectomy only is the best management for ALI. This study aims to determine the best management for the case being reported according to literature search and critical reviews collected from medical research database.
Method: From the data collected, there was one interesting case, which is a case about acute limb ischemia, and the following operative management. Afterwards, a literature search was conducted to obtain articles related to the case, and critical review was made regarding the selected article.
Results: At the end of the literature search, we found two articles which showed better outcome on hybrid procedure compared to surgical thrombectomy. Compared to the group who underwent thrombectomy, there was decreased 30-days mortality in the group who underwent the hybrid procedure (3.3% vs 4.4%, p-value 0.05), decreased incidence of amputations after 30 days (6.49% vs 13.5%, p-value 0.023), increased limb salvage (91.9% vs 82.3%, p-value 0.03, 95% CI), and decreased two-years mortality (18.7% vs 40.5%; p– value <0.001).
Conclusion: Critical review on articles obtained from literature search in online database showed that the outcome hybrid procedure was better than surgical thrombectomy only.
Keywords: acute limb ischemia; hybrid procedure; thrombectomy; outcome