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Percutaneous Mechanical Thromboembolectomy in Acute Lower Limb Ischemia

  • Clinical Investigation
  • Arterial Interventions
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Abstract

Purpose

To analyze the immediate outcome of percutaneous mechanical thromboembolectomy in acute infrainguinal leg ischemia in a consecutive cohort of patients with acute lower limb ischemia.

Material and Method

We retrospectively analyzed the data of 156 acute infrainguinal ischemic events in 148 patients. Patients presented with acute limb ischemia Rutherford category I in 68 cases (44%), Rutherford category II A in 64 instances (41%) and Rutherford II B in 24 instances (15%). In 62 cases (39.7%), the occlusion site started below the knee joint level, in 94 (60.3%) cases above. As a basic technique, an intervention was started by manual aspiration but if aspiration failed, an additional device was added. Most frequently, a rotational thrombectomy device (Rotarex, Straub Medical, Wangs, Switzerland) was used. An antegrade access to the femoral artery was the preferred access to the limb (154/156).

Results

In 145 of 156 incidents, a technical success was achieved (93%). Aspiration was used in 153 cases (98%). Rotational thrombectomy by use of the Rotarex catheter was added in 60 cases (38%). Directional atherectomy was applied in a total of five patients. As main technical complications, a downward embolization occurred (n = 11). There were four surgical groin revisions. Five patients died during the early follow-up with four not related to the intervention. Clinically, 135 patients (86.5%) showed an improvement in their clinical situation.

Conclusion

Acute lower limb ischemia can be successfully treated by mechanical thromboembolectomy only by combining aspiration embolectomy with rotational thrombectomy in most cases but manual aspiration alone will frequently fail especially above the knee joint level.

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References

  1. Starck E, McDermott J, Crummy A, Turnipseed W, Acher C, Burgess J. Percutaneous aspiration thromboembolectomy. Radiology. 1985;156:51–6.

    Article  Google Scholar 

  2. Sniderman K, Bodner L, Saddekni S, Srur M, Sos T. Percutaneous embolectomy by transcatheter aspiration. Work in progress. Radiology. 1984;150:357–61.

    Article  CAS  PubMed  Google Scholar 

  3. Rutherford R, Flanigan P, Gupta S, Johnson W, Karmody A, Whittemore A, Baker D, Ernst C, Jamieson C, Mehta S. Suggested standards for reports dealing with lower extremity ischemia. J Vasc Surg. 1986;4:80–94.

    Article  Google Scholar 

  4. Dregelid E, Stangeland L, Eide G, Trippestad A. Patient survival and limb prognosis after arterial embolectomy. Eur J Vasc Surg. 1987;18:263–71.

    Article  Google Scholar 

  5. Morrison H. Catheter-directed thrombolysis for acute limb ischemia. Semin Interv Radiol. 2006;23:258–69.

    Article  Google Scholar 

  6. Filippiadis D, Binkert C, Pellerin O, Hoffmann R, Krajina A, Pereira P. Cirse quality assurance document and standards for classification of complications: the Cirse classification system. Cardiovasc Interv Radiol. 2017;40:1141–6.

    Article  CAS  Google Scholar 

  7. Rajan D, Patel N, Valji K, Cardella J, et al. Quality improvement guidelnes for percutaneous management of acute limb ischemia. J Vasc Intervent Radiol. 2009;20:S208–18.

    Article  Google Scholar 

  8. Kashiap V, Gilani R, Bena J, Bannazadeh M, Sarac T. Endovascular therapy for acute limb ischemia. J Vasc Surg. 2011;53:340–6.

    Article  Google Scholar 

  9. Wagner H, Starck E. Acute embolic occlusions of the infrainguinal arteries: percutaneous aspiration embolectomy in 102 patients. Radiology. 1992;182:403–7.

    Article  CAS  PubMed  Google Scholar 

  10. Zeller T, Frank U, Bürgelin K, Müller C, Flügel P, Horn B, Schwarzwälder U, Neumann F. Early experience with a rotational thrombectomy device for treatment of acute and subacute infra-aortic arterial occlusions. J Endovasc Ther. 2003;10:322–31.

    PubMed  Google Scholar 

  11. Duc S, Schoch E, Pfyffer M, Jenelten R, Zollikofer C. Recanalization of acute and subacute femoropopliteal artery occlusions with the rotarex catheter: one year follow-up, single center experience. Cardiovasc Interv Radiol. 2005;28:603–10.

    Article  Google Scholar 

  12. Heller S, Lubanda J, Varejka P, Chochola M, Prochazka P, Rucka D, Kuchynkova S, Horakova J, Linhart A. Percutaneous mechanical thrombectomy using Rotarex S device in acute limb ischemia in infrainguinal occlusions. BioMed Res Int. 2017;1:1. https://doi.org/10.1155/2017/2362769.

    Article  Google Scholar 

  13. Kwok CHR, Fleming S, Chan K, Tibballs J, Samuelson S, Ferguson J, Nadkarni S, Hockley J, Jansen S. Aspiration thrombectomy versus conventional catheter-directed thrombolysis as first-line treatment for noniatrogenic acute lower limb ischemia. J Vasc Interv Radiol. 2018;29:607–13.

    Article  PubMed  Google Scholar 

  14. Vorwerk D, Guenther RW, Schürmann K. Stent placement on fresh venous thrombosis. Cardiovasc Interv Radiol. 1997;20:359–63.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Klinikum Ingolstadt, Ingolstadt, Germany

    Dierk Vorwerk, Stefan Triebe & Steffen Ziegler

  2. Department of Vascular Surgery, Klinikum Ingolstadt, Ingolstadt, Germany

    Volker Ruppert

Authors
  1. Dierk Vorwerk
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  2. Stefan Triebe
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  3. Steffen Ziegler
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  4. Volker Ruppert
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Correspondence to Dierk Vorwerk.

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The authors declare that they have no conflict of interest.

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Vorwerk, D., Triebe, S., Ziegler, S. et al. Percutaneous Mechanical Thromboembolectomy in Acute Lower Limb Ischemia. Cardiovasc Intervent Radiol 42, 178–185 (2019). https://doi.org/10.1007/s00270-018-2129-3

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  • DOI: https://doi.org/10.1007/s00270-018-2129-3

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