A Laser Atherectomy-Thrombectomy System for Primary Management of Acute Limb Ischemia

Purpose: To evaluate the primary use of a laser atherectomy-thrombectomy system in patients with acute limb ischemia (ALI). Materials and Methods: A single-center retrospective review of patients presenting with ALI (≤14 days) from August 2021 to February 2024 treated primarily with a laser atherectomy-thrombectomy system (Auryon; AngioDynamics, Queensbury, New York) was performed. Technical success was defined by resolution of the acute occlusion with adequate inflow and outflow with pedal signals detectable by handheld Doppler ultrasound (US). The primary clinical endpoints were resolution of symptoms without readmission or reintervention in the immediate postprocedural period and at 30 days with follow-up duplex US documenting patency of the treated limb. Twenty-four procedures in 21 patients were included (mean age, 60 years; males:females, 12:9). Seventy-five percent (18/24) of patients presented with Rutherford 1, 12.5% (3/24) presented with Rutherford 2A, and 12.5% (3/24) presented with Rutherford 2B, with a mean symptom duration of 4 days. Results: Technical success was 92% (22/24) in a single session. Two technical failures required overnight adjuvant thrombolysis. All patients met the immediate postprocedural endpoint, and 92% met the 30-day endpoint. There were no major device-related adverse events or deaths within 30 days, with a major amputation rate of 5%. Distal embolization occurred in 7 (29%) of cases, most of which were focal tibial emboli occurring after adjunctive plain balloon clot maceration and resolved with balloon maceration and/or additional passes of the laser atherectomy-thrombectomy system. Conclusions: The use of a laser atherectomy-thrombectomy system is a feasible option as a primary treatment modality for ALI.