Lower extremity extracorporeal distal revascularization (LEEDR) as a novel approach to limb salvage following prolonged ischemia

Acute limb ischemia necessitates prompt revascularization to preserve viability and minimize systemic ischemia–reperfusion injury. Delays in care increase morbidity and mortality, underscoring the need for nonsurgical temporizing methods. Lower Extremity Extracorporeal Distal Revascularization (LEEDR) is a percutaneous technique that delivers oxygenated blood from the contralateral femoral artery to the ischemic limb via a retrograde tibial cannula. This study aimed to evaluate LEEDR compared to prolonged untreated warm ischemia. Anesthetized Yorkshire swine (40–60 kg) underwent hindlimb ischemia via endovascular balloon occlusion of the left external iliac and middle sacral arteries and were randomized to control (n = 6; 9 h ischemia) or LEEDR (n = 6; 1-h ischemia plus 8 h extracorporeal support). Revascularization was achieved by balloon deflation, followed by 48 h of observation. The primary outcome was survival; secondary outcomes included gait function, compartment pressure, and biochemical markers of ischemia–reperfusion injury. Survival was significantly higher in the LEEDR group (83% vs. 0%; p =.001). LEEDR animals demonstrated improved gait function (5.8 ± 0.34 vs. 2.5 ± 0.7; p <.001), lower compartment pressures (9.9 ± 1.7 vs. 28.5 ± 4.2 mm Hg; p <.001), and reduced serum potassium (4.57 ± 0.22 vs. 5.14 ± 0.54 mmol/L; p <.001) and lactate concentrations (1.4 ± 0.55 vs. 2.5 ± 1.6 mmol/L; p <.001) during reperfusion and recovery. LEEDR effectively mitigated the consequences of 9 h of warm ischemia in a swine model, improving survival, preserving limb function, and preventing compartment syndrome. This percutaneous technique may serve as a viable temporizing strategy in patients with delayed access to definitive revascularization.