Endovascular Management of Subacute Lower Extremity Ischemia

Patients presenting with >14 days lower extremity ischemia are usually considered as chronic; however, patients with subacute (>14 days and <3 months) and chronic (>3 months) occlusions often have organizing thrombus. This is not considered in current recommendations for the treatment of nonacute leg ischemia and, with the increased use of endovascular interventions, more complex lesions with long occlusions are treated percutaneously. Thrombolysis alone has been reported to successfully decrease this clot load in a significant proportion of patients with subacute occlusions, and percutaneous thrombectomy devices were suggested as a means to decrease the hemorrhagic complications associated with thrombolysis. However, distal embolization remains a problem, which these interventions are intended to prevent. In this article, we aim to review the current literature on the endovascular treatment of patients with subacute arterial occlusions, and review our experience.