Technically Successful Mechanical Thrombectomy for Acute Lower-Limb Ischaemia and 30-day Limb Salvage: A Single-centre Study

PURPOSE: To describe lesion extent, post-thrombectomy angiographic flow, and early outcome after mechanical thrombectomy for acute lower-limb ischaemia, and to assess whether angiographic technical success by Thrombo-aspiration in Peripheral Ischaemia (TIPI) grade is concordant with 30-day limb salvage. MATERIALS AND METHODS: This retrospective single-centre registry study included 69 acute lower-limb mechanical thrombectomy procedures from 100 lower-limb interventions in 2019-2025. Target segments, thrombus extent, post-thrombectomy TIPI grade, and 30-day outcomes were analysed at the procedure level. Angiographic technical success was defined as TIPI grade 2-3. The primary endpoint was 30-day limb salvage. Paired discordance was assessed using the exact McNemar test. RESULTS: Median age was 71.0 years, 25/69 limbs (36.2%) had Rutherford IIb ischaemia, and multilevel thrombosis was present in 62/69 procedures (89.9%). Tibioperoneal/tibial involvement was present in 56/69 (81.2%), and pedal arch/foot involvement in 20/69 (29.0%). Post-thrombectomy TIPI grades were 0 in 1/69, 2 in 41/69, and 3 in 27/69 procedures; angiographic technical success was achieved in 68/69 (98.6%; 95% CI, 92.2-100.0). Thirty-day limb salvage was 59/69 (85.5%; 95% CI, 75.0-92.8), with a paired gap of 13.0 percentage points. Exact McNemar testing showed discordance (p = 0.0039): 9 of 10 limbs not salvaged had angiographic technical success. Distal embolization was evaluable in 66 procedures and occurred in 16/66 (24.2%); 30-day mortality was 6/69 (8.7%). CONCLUSION: Angiographic technical success by TIPI grade 2-3 was frequent but not fully concordant with 30-day limb salvage. These findings support reporting post-thrombectomy flow and downstream perfusion rather than relying on target-segment technical success alone.