Outcomes of AngioJet™ Rheolytic Thrombectomy for Occluded Lower-Extremity Bypass Grafts: A Single-Center Retrospective Study
Bachar Al Haj, Martin J. Austermann, Marco V. UsaiBackground:
Lower-extremity bypass graft occlusion is associated with recurrent ischemia and potential limb loss. This study evaluated the technical and clinical outcomes of AngioJet™ rheolytic thrombectomy for occluded bypass grafts in a single-center retrospective cohort.
Methods:
Consecutive patients undergoing AngioJet™ thrombectomy as the primary strategy for occluded bypass grafts (2014-2024) were reviewed. Technical success was defined as <30% residual stenosis. Outcomes included Rutherford category improvement, complications, 30-day mortality, major amputation, target lesion revascularization, and primary patency. Follow-up was available for 38/40 (95.0%) 30-day survivors.
Results:
Forty-one procedures were analyzed. Technical success was achieved in 38/41 (92.7%; 95% confidence interval [CI]: 80.1%-98.5%). Periprocedural complications occurred in 4 patients (9.8%; 95% CI: 2.7%-23.1%). Thirty-day mortality was 2.4% (1/41; 95% CI: 0.1%-12.9%) and major amputation was 4.9% (2/41; 95% CI: 0.6%-16.5%). Rutherford category improvement at 30 days was 43.9% (18/41; 95% CI: 28.5%-60.3%). Primary patency at final follow-up was 63.4% (26/41; 95% CI: 46.9%-77.9%) in the overall cohort (intent-to-treat) and 68.4% (26/38; 95% CI: 51.3%-82.5%) among technically successful cases.
Conclusion:
AngioJet™ thrombectomy is a technically feasible endovascular option for occluded bypass grafts with low 30-day mortality (2.4%) and amputation rates (4.9%). Prospective comparative studies are needed to define its role relative to surgical and alternative endovascular approaches.
Clinical Impact
Occluded lower-extremity bypass grafts often cause limb-threatening ischemia in patients at high surgical risk. In this single-center cohort, AngioJet rheolytic thrombectomy achieved technical success in 92.7% of procedures, with 30-day mortality of 2.4% and major amputation of 4.9%. These findings support AngioJet-assisted thrombectomy as a minimally invasive option for carefully selected patients with crossable grafts and treatable inflow or outflow disease. Clinicians should anticipate adjunctive interventions, monitor for compartment syndrome, and provide structured surveillance because reintervention remains common. Prospective comparative studies are needed before routine first-line use.