Tesis

Perbandingan Open Thrombectomy dan Percutaneous Thrombectomy pada Pasien Acute Limb Ischemia terhadap Angka Amputasi Mayor dan Kematian di RSUPN Dr. Cipto Mangunkusumo = Comparison of Open Thrombectomy and Percutaneous Thrombectomy in Patients with Acute Limb Ischemia on Major Amputation and Mortality at Cipto Mangunkusumo Hospital.

Pendahuluan: Acute Limb Ischemia (ALI) merupakan keadaan darurat vaskular akibat terjadinya penurunan perfusi arteri secara mendadak yang dapat menyebabkan kehilangan ekstremitas dan kematian bila tidak ditangani secara cepat. Dua modalitas revaskularisasi utama pada ALI adalah open thrombectomy dan percutaneous thrombectomy. Meskipun keduanya bertujuan memulihkan aliran darah, perbedaan invasivitas, waktu reperfusi, dan profil komplikasi dapat memengaruhi luaran klinis. Hingga saat ini, data komparatif mengenai angka amputasi mayor dan mortalitas antara kedua metode di Indonesia, khususnya di RSUPN Dr. Cipto Mangunkusumo, masih terbatas. Metode: Penelitian ini menggunakan desain kohort retrospektif dengan sumber data rekam medis pasien ALI yang menjalani tindakan open thrombectomy atau percutaneous thrombectomy di RSCM pada periode Januari 2022 hingga Juli 2025. Subjek penelitian adalah pasien dewasa berusia >18 tahun dengan ALI Rutherford IIa–IIb dan masa tindak lanjut minimal 6 bulan. Variabel bebas adalah jenis tindakan thrombectomy, sedangkan variabel terikat meliputi kejadian amputasi mayor dan mortalitas. Analisis bivariat dilakukan dengan uji chi-square atau Fisher, sedangkan analisis multivariat menggunakan regresi logistik untuk mengendalikan faktor perancu seperti usia, derajat iskemia, komorbiditas, dan ischemic time. Hasil: Sebanyak 45 pasien diikutsertakan dengan usia rata-rata 58,8 ± 15,9 tahun, dan 60% berjenis kelamin perempuan. Tindakan percutaneous thrombectomy dilakukan pada 23 pasien (51,1%) dan open thrombectomy pada 22 pasien (48,9%). Kejadian amputasi mayor ditemukan pada 29 pasien (64,4%), dengan proporsi lebih tinggi pada kelompok open thrombectomy (55,2%) dibandingkan percutaneous thrombectomy (44,8%), namun tidak berbeda bermakna secara statistik (p=0,232). Analisis multivariat menunjukkan bahwa jenis tindakan tidak berpengaruh signifikan terhadap amputasi mayor (aOR 0,768; p=0,768). Faktor yang berhubungan signifikan dengan amputasi mayor adalah derajat iskemia Rutherford IIb (aOR 52,93; p=0,002). Mortalitas terjadi pada 6 pasien (15%) dan tidak berbeda antara kedua kelompok (p=1,000). Kesimpulan: Tidak terdapat perbedaan bermakna antara open thrombectomy dan percutaneous thrombectomy terhadap angka amputasi mayor maupun mortalitas pada pasien ALI di RSUPN. Dr. Cipto Mangunkusumo. Derajat keparahan iskemia merupakan faktor prediktor utama terjadinya amputasi mayor. Pemilihan metode revaskularisasi sebaiknya mempertimbangkan kondisi klinis pasien dan derajat iskemia.
Kata kunci: Acute Limb Ischemia, Open Thrombectomy, Percutaneous Thrombectomy, Amputasi Mayor, Mortalitas


Introduction: Acute Limb Ischemia (ALI) is a vascular emergency characterized by a sudden decrease in arterial perfusion that may lead to limb loss and death if not promptly treated. Open thrombectomy and percutaneous thrombectomy are the two main revascularization strategies for ALI. Despite having the same goal of restoring blood flow, differences in invasiveness, reperfusion time, and complication profiles may influence clinical outcomes. However, comparative local data regarding major amputation and mortality between these two modalities in Indonesia remain limited. Methods: This retrospective cohort study was conducted using medical records of ALI patients who underwent open or percutaneous thrombectomy at Cipto Mangunkusumo Hospital from January 2022 to July 2025. Adult patients (>18 years) with Rutherford class IIa–IIb ALI and a minimum follow-up of six months were included. The independent variable was the type of thrombectomy, while the dependent variables were major amputation and mortality. Bivariate analysis was performed using chi-square or Fisher’s exact test, and multivariate analysis was conducted using logistic regression to adjust for confounding factors such as age, ischemic severity, comorbidities, and ischemic time. Results: A total of 45 patients were included, with a mean age of 58.8 ± 15.9 years, and 60% were female. Percutaneous thrombectomy was performed in 23 patients (51.1%) and open thrombectomy in 22 patients (48.9%). Major amputation occurred in 29 patients (64.4%), with a higher proportion in the open thrombectomy group (55.2%) compared to the percutaneous group (44.8%), although the difference was not statistically significant (p=0.232). Multivariate analysis showed that the type of thrombectomy was not significantly associated with major amputation (aOR 0.768; p=0.768). Rutherford IIb classification was the only significant predictor of major amputation (aOR 52.93; p=0.002). Mortality occurred in six patients (15%) and did not differ between the two groups (p=1.000). Conclusion: There is no significant difference in major amputation and mortality rates between open thrombectomy and percutaneous thrombectomy in patients with ALI at Cipto Mangunkusumo Hospital. The severity of ischemia remains the main determinant of limb loss. Treatment decisions should be individualized based on clinical condition and ischemic severity.
Keywords: Acute Limb Ischemia, Open Thrombectomy, Percutaneous Thrombectomy, Major Amputation, Mortality