Single-center Experience with JETi Hydrodynamic Thrombectomy System for Arterial Occlusions of the Extremities

Percutaneous aspiration thrombectomy is a new modality for treating patients with acute limb ischemia. We report our experience and outcomes using the JETi hydrodynamic thrombectomy system (Abbott Vascular, Abbott Park, IL) to treat acute arterial occlusions of the extremities. This is a single-center retrospective review of acute occlusions of peripheral arteries/grafts treated with the JETi from September 2020 to December 2022. JETi was used either as primary intervention or as an adjunct to treat distal vessel thrombus after proximal open thrombectomy. The primary outcome for success was defined as >50% luminal opening post-intervention. Indications, limb salvage, and major adverse events were reviewed. The JETi was used in 59 procedures (56 acute lower extremity ischemia [ALEI], 3 acute upper extremity ischemia) to treat 124 arteries in 57 patients. Mean age was 62 years (range, 29-95 years) and 49% were male. The mean duration of symptoms before hospitalization was 4.8 days (range, 0 hours to 21 days) for ALEI. The primary outcome was achieved in 102 of 124 arteries by JETi alone (83%). Additional modalities including open thrombectomy, angioplasty, and stenting were used in five arteries to achieve the primary outcome. Seventeen arteries failed to achieve primary outcome with JETi with or without an adjunct. Reasons for failure were attributed to small artery size and chronic nature of the clot. Complete luminal patency with JETi thrombectomy alone was achieved in 52 arteries (42%). Additionally, 55 arteries underwent angioplasty/stenting to restore complete luminal patency, which was successfully achieved in 49 vessels (89%) (Table). Complications included distal embolization (n = 5), access site hematoma (n = 3), and acute kidney injury (n = 8). There was a single 30-day mortality. Six patients required major limb amputations within 30 days, two after unsuccessful recanalization and one each for severe gangrene despite restoration of in-line flow, reocclusion of a distal bypass graft, recurrent ALEI postoperative day 15 with nonviable muscle on exploration, and a delayed compartment syndrome diagnosis. Success of the JETi to remove the targeted clot was 83%. The JETi system is an efficacious and safe tool for use in the treatment of acute artery occlusion.TableName of artery/graftNo. of each vesselJETi > 50%JETi + adjunctive >50%JETi 100%JETi + adjunctive 100%JETi + adjunctive 50更多