Comparative outcomes and costs of AngioJet™ versus lysis-first strategy in acute limb ischemia treatment.

Background: This study compared outcomes of a pharmacomechanical thrombectomy (PMT)-first strategy using the AngioJet™ system versus catheter-directed thrombolysis (CDT) in the treatment of acute limb ischemia (ALI). Patients and methods: We retrospectively analysed 100 patients with ALI (Rutherford I-IIb) treated between January 2016 and September 2024. Patients received either primary PMT with AngioJet™ (n = 57) or primary CDT (n = 43). The primary endpoint was amputation-free survival (AFS). Secondary endpoints included technical success, major amputation, mortality, reintervention, and in-hospital cost. Cox regression was used for time-to-event data; cost analysis employed a generalised linear model. Results: Technical success was higher with AngioJet™ (96.5% vs. 65.1%, p < .001). Median thrombolysis duration (1 h vs. 24 h, p < .001), hospital stay (6 vs. 11 days, p = .002), and ICU stay (1 vs. 2 days, p < .001) were significantly reduced. Median inpatient costs were lower in the AngioJet™ group (€9,298 vs. €13,790; exp(B) 1.308, 95% CI 1.07-1.6, p = .009). No significant differences were observed in 30-day mortality, major amputation, bleeding, or acute kidney injury. At 12-months AFS was similar (57.9% vs. 51.2%, p = .55). While major amputation was less frequent after AngioJet™ (5.4% vs. 18.6%, p = .05), this was not significant in multivariate analysis. CDT was independently associated with higher reintervention rates (HR 2.57, p = .03). Conclusions: In this cohort, a primary AngioJet™ strategy was associated with advantages in technical outcomes, hospitalisation, costs, and reinterventions, while amputation-free survival remained comparable to primary CDT. These findings support its use as an effective endovascular option in selected ALI patients.