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Xu J, Yu Q, Zhu G, Zhao Z, Xiao Y, Bao J, Yuan L. Sex-related differences in the effect of rotational thrombectomy for thrombus-containing lower limbs ischemic lesions. Thromb J 2022; 20:78. [PMID: 36527031 PMCID: PMC9758767 DOI: 10.1186/s12959-022-00437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To assess the immediate effect and factors affecting the efficacy of rotational thrombectomy (RT) in patients with thrombus-containing lower-limb ischaemic lesions. METHODS Patients were retrospectively divided into two groups: RT and RT+ CDT (Catheter-directed thrombolysis). The RT group included patients in whom intraoperative thrombus aspiration was successful, while the RT + CDT group included patients in whom intraoperative thrombus aspiration was less effective and remedial CDT treatment was used. The primary outcome was the immediate effect of RT on thrombus-containing lower-limb ischaemic lesions. RESULTS From May 2015 to July 2021, 170 patients (113 men, 57 women; mean age, 74.0 years) with thrombus-containing lower-limb ischaemic lesions were treated in our centre. Of these patients, 113 received RT only, while 57 received RT + CDT. There were no significant intergroup differences in terms of age, disease duration, or comorbidities, but a higher proportion of male patients and higher preoperative plasma D-dimer levels (1.23 vs. 0.84; p = .017) was observed in the RT + CDT group. There were no significant intergroup differences in terms of diagnosis, lesion characteristics, lesion location, or lesion length. Multivariate logistic regression analysis revealed that male sex (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.098-6.410; p = .030) and poor distal runoff (OR, 2.94; 95% CI, 1.439-5.988; p = .003) were associated with higher rates of additional CDT. Male patients also had a significantly longer onset time, more thrombotic occlusions, and a greater frequency of in-stent restenosis. CONCLUSIONS RT alone or with CDT is a feasible primary treatment option for thrombus debulking. Sex significantly influences the effect of RT on thrombus-containing lower-limb ischaemic lesions.
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Affiliation(s)
- Jinyan Xu
- grid.411525.60000 0004 0369 1599Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168 Changhai Road, Shanghai, 200433 People’s Republic of China
| | - Qingyuan Yu
- grid.411525.60000 0004 0369 1599Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168 Changhai Road, Shanghai, 200433 People’s Republic of China
| | - Guanglang Zhu
- grid.8547.e0000 0001 0125 2443Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, Affiliated to Fudan University, Shanghai, 201700 China
| | - Zhiqing Zhao
- grid.411525.60000 0004 0369 1599Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168 Changhai Road, Shanghai, 200433 People’s Republic of China
| | - Yu Xiao
- grid.411525.60000 0004 0369 1599Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168 Changhai Road, Shanghai, 200433 People’s Republic of China
| | - Junmin Bao
- grid.411525.60000 0004 0369 1599Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168 Changhai Road, Shanghai, 200433 People’s Republic of China
| | - Liangxi Yuan
- grid.411525.60000 0004 0369 1599Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, 168 Changhai Road, Shanghai, 200433 People’s Republic of China
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Fan W, Lu S, Tan J, Cui X, Liang K, Zhu L, He Q, Yu B, Shi W. Midterm Results of Drug-Coated Balloon Alone or Combined with Rotarex Thrombectomy Device for Treatment of Subacute Femoropopliteal Artery Thrombotic Occlusion. Ann Vasc Surg 2022; 92:240-248. [PMID: 36503024 DOI: 10.1016/j.avsg.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/23/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND This retrospective multicenter study aimed to compare the midterm results of the Rotarex rotational thrombectomy device combined with drug-coated balloon (DCB) and DCB-alone for the treatment of subacute femoropopliteal artery thrombotic occlusion. METHODS All patients (74, aged 70.1 ± 9.3 years) were nonrandomized and divided into 2 groups based on treatment strategy between 2018 and 2020. Intraoperative technical success (defined as <30% residual stenosis), dissection types and bailout-stenting rates were assessed. Ankle-brachial index (ABI), primary patency (PP, restenosis <50%) and freedom from clinically driven target lesion reintervention (CD-TLR) were documented at follow-up. RESULTS Among them, 35 patients were treated with the Rotarex catheter combined with DCB while 39 patients underwent DCB-alone. The-overall technical success rate was 100%. Patients in the Rotarex + DCB group showed lower rate of bailout stenting than those in the DCB alone group (22.9% vs. 59.0%; P = 0.01). ABI at discharge was significantly higher in both groups. Mean follow-up time was 18.5 ± 3.4 months; 62 patients completed Doppler ultrasound investigation while 12 patients were censored. According to Kaplan-Meier analysis, the estimated PP was 82.0 ± 6.7% in the Rotarex + DCB group, whereas a significantly lower rate in the DCB alone group (60.9 ± 8.3%, P = 0.04). In addition, the freedom from CD-TLR rate was 82.9 ± 6.4% in the Rotarex + DCB group and 61.5 ± 7.8% in the DCB-alone group (P = 0.04). CONCLUSIONS These initial data indicate that the Rotarex thrombectomy device combined with DCB is an effective choice for the treatment of subacute femoropopliteal artery thrombotic occlusion compared to DCB-alone. The combined procedure had superior midterm results.
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Affiliation(s)
- Weijian Fan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China; Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, PR China
| | - Shuangshuang Lu
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Jinyun Tan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China; Fudan Zhangjiang Institute, Shanghai, PR China
| | | | - Kun Liang
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Lei Zhu
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Qing He
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Bo Yu
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, PR China; Fudan Zhangjiang Institute, Shanghai, PR China.
| | - Weihao Shi
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China.
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Wang CC, Lu CR, Hsieh LC, Kuo CC, Huang PW, Chang KC, Chang CT, Hsu CH. Comparison of pharmaco-mechanical thrombolysis and catheter-directed thrombolysis for treating thrombotic or embolic arterial occlusion of the lower limb. INT ANGIOL 2022; 41:292-302. [PMID: 35437980 DOI: 10.23736/s0392-9590.22.04809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Whether pharmaco-mechanical thrombolysis (PMT) results in superior outcomes to catheter-directed thrombolysis (CDT) in treating thrombotic or embolic arterial occlusion of the lower limbs is unclear. METHODS We enrolled 94 patients with Rutherford class I-IIb due to thrombotic or embolic arterial occlusion in the lower limbs and who received emergency endovascular treatment. Baseline demographics, laboratory data, angiography and clinical outcomes were collected through chart reviews and fluoroscopic imaging. The procedural characteristics (thrombolytic drug dosage, treatment duration, and additional procedures), immediate angiographic outcomes (patency of calf vessels, and complete lysis), complications (major bleeding, and fasciotomy), and primary composite end-points (30-day mortality, amputation, and reocclusion) were compared between patients who received CDT versus PMT. RESULTS Compared with CDT, PMT was independently associated with lower total UK dosage (standardised coefficientβ= - 0.44; p < 0.01) and higher prevalence of complete lysis (odds ratio = 1.78, 95% confidence interval: 1.03 - 3.06; p = 0.04) after adjustments of covariates. The PMT group had significantly shorter treatment duration (23.00 [7.25 - 39.13] vs. 41.00 [27.00 - 52.50]; p < 0.01). No significant intergroup differences were observed for the primary composite end point (10.7% vs. 9.1%; p = 0.81), or prevalence of the major bleeding (9.1% vs. 0.0%; p = 0.10) despite the PMT group comprising patients with more.advanced chronic kidney disease and more diffuse thrombosis. CONCLUSIONS PMT with a Rotarex is a safe and effective strategy for treating thrombotic or embolic lower limb ischemia. It significantly reduced the thrombolytic drug dosage, and resulted in the complete lysis being more likely.
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Affiliation(s)
- Chun-Cheng Wang
- School of Medicine, China Medical University, Thaicung, Taiwan.,Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chiung-Ray Lu
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Li-Chuan Hsieh
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chin-Chi Kuo
- School of Medicine, China Medical University, Thaicung, Taiwan.,Big Data Center, China Medical University Hospital, Thaicung, Taiwan.,Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Wen Huang
- Big Data Center, China Medical University Hospital, Thaicung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Cheng Chang
- School of Medicine, China Medical University, Thaicung, Taiwan.,Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chiz-Tzung Chang
- School of Medicine, China Medical University, Thaicung, Taiwan.,Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan
| | - Chung-Ho Hsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hospital, Thaicung, Taiwan -
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Pan T, Tian SY, Liu Z, Zhang T, Li C, Ji DH. Combination of Rotarex ⓇS Rotational Atherothrombectomy and Drug-Coated Balloonangioplasty for Femoropopliteal Total In-Stent Occlusion. Ann Vasc Surg 2021; 80:213-222. [PMID: 34748945 DOI: 10.1016/j.avsg.2021.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Currently, there is little information on the optimal treatment for patients with femoropopliteal total in-stent occlusion.The aim of this study was to evaluate the benefit of drug-coated balloon(DCB) angioplasty after RotarexⓇS rotational atherectomy plus thrombectomy for femoropopliteal total in-stent occlusion at 12 months. METHODS From June 2016 to April 2019, 36 patients (21 male, mean age 71.1 ± 8.2 years) with femoropopliteal total in-stent occlusion were treated using Rotarex S rotational atherectomy plus thrombectomy in combination with DCB angioplasty and 29 (18 male, meanage68.8 ± 7.2 years) underwent DCB angioplasty alone. Primary patency and freedom from target lesion revascularization (TLR) rates during12 months of follow-up were retrospectively compared between the 2 groups. RESULTS Procedural success was achieved in all patients. There were no procedure-related adverse events. The mean lesion length was 26.1 ± 6.5 cm in the combination therapy group and 25.5 ± 6.1 cm in the DCB only group (P = 0.703). The 6-month and 12-month primary patency rates were significantly higher in the combination therapy group (94.4% [standard error, 0.038] and 77.8% [0.069], respectively) than in the DCB only group (72.4% [0.083] and 48.3% [0.093]; P = 0.010). The freedom from TLR rate at 12 months was 86.1% (standard error, 0.060) in the combination therapy group and 62.1% (0.096) in the DCB only group (P = 0.016). Three patients (combination therapy, n = 2; DCB only, n = 1) developed distal embolization and were treated successfully by additional 6-F guiding catheter aspiration. No deaths or amputations occurred in either group during 12 months of follow-up. CONCLUSIONS Rotarex S rotational atherectomy plus thrombectomyin combination with DCB was safe and effective in patients with femoropopliteal total in-stent occlusion during12 months of follow-up.
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Affiliation(s)
- Tao Pan
- The Interventional Therapy department of the first Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shi-Yun Tian
- Department of radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhen Liu
- The Interventional Therapy department of the first Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tao Zhang
- The Interventional Therapy department of the first Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cheng Li
- The Interventional Therapy department of the first Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dong-Hua Ji
- The Interventional Therapy department of the first Affiliated Hospital of Dalian Medical University, Dalian, China.
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Nguyen KT, Kim SJ, Min HK, Hoang MC, Go G, Kang B, Kim J, Choi E, Hong A, Park JO, Kim CS. Guide-Wired Helical Microrobot for Percutaneous Revascularization in Chronic Total Occlusion in-Vivo Validation. IEEE Trans Biomed Eng 2021; 68:2490-2498. [PMID: 33351745 DOI: 10.1109/tbme.2020.3046513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE For the revascularization in small vessels such as coronary arteries, we present a guide-wired helical microrobot mimicking the corkscrew motion for mechanical atherectomy that enables autonomous therapeutics and minimizing the radiation exposure to clinicians. METHODS The microrobot is fabricated with a spherical joint and a guidewire. A previously developed external electromagnetic manipulation system capable of high power and frequency is incorporated and an autonomous guidance motion control including driving and steering is implemented in the prototype. We tested the validity of our approach in animal experiments under clinical settings. For the in vivo test, artificial thrombus was fabricated and placed in a small vessel and atherectomy procedures were conducted. RESULTS The devised approach enables us to navigate the helical robot to the target area and successfully unclog the thrombosis in rat models in vivo. CONCLUSION This technology overcomes several limitations associated with a small vessel environment and promises to advance medical microrobotics for real clinical applications while achieving intact operation and minimizing radiation exposures to clinicians. SIGNIFICANCE Advanced microrobot based on multi-discipline technology could be validated in vivo for the first time and that may foster the microrobot application at clinical sites.
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Liu J, Li T, Huang W, Zhao N, Liu H, Zhao H, Xu J, Wang H. Drug-coated balloons used in peripheral artery disease: experience from a single center. J Int Med Res 2021; 48:300060520940157. [PMID: 32762385 PMCID: PMC7416143 DOI: 10.1177/0300060520940157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This retrospective single-center study aimed to analyze immediate and follow-up results of using drug-coated balloons (DCBs) for treating peripheral arterial disease. METHODS In this study, we identified a total of 75 patients who underwent DCB therapy at our institution. The ankle-brachial index (ABI) was measured before and after intervention. Intermittent claudication and whether there was healing of ulcers were determined by telephone. RESULTS The cohort consisted of 56 men and 19 women aged 38 to 87 years (68 ± 12 years). Twenty-three patients had Rutherford grade III, 15 had Rutherford grade IV, and 37 had Rutherford grade V. Seventeen patients had stents and 18 had the Rotarex system used. The postoperative ABI was significantly greater than the preoperative ABI (0.911 ± 0.173 vs 0.686 ± 0.249). Good results for treatment were obtained. Intermittent claudication and rest pain did not occur in subjects with Rutherford grades III and IV during follow-up. The amputation rate was 4.1% among all patients using DCB therapy during follow-up. CONCLUSIONS DCB therapy is safe and effective for treating peripheral arterial disease in real-world patients. Future prospective studies on this issue are recommended.
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Affiliation(s)
- Jinbo Liu
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Tianrun Li
- Department of Interventional Vascular Surgery, Peking University Third Hospital, Beijing, P. R. of China
| | - Wei Huang
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Na Zhao
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Huan Liu
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Hongwei Zhao
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China
| | - Jiufeng Xu
- Department of Orthopedics, Peking University Third Hospital Yanqing Hospital, Beijing, P. R. of China
| | - Hongyu Wang
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing, P. R. of China.,Vascular Health Research Center of Peking University Health Science Center, Beijing, China
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Stahlberg E, Anton S, Sieren M, Wegner F, Barkhausen J, Goltz JP. Mechanical rotational thrombectomy in long femoropopliteal artery and bypass occlusions: risk factors for periprocedural peripheral embolization. ACTA ACUST UNITED AC 2021; 27:249-256. [PMID: 33599205 DOI: 10.5152/dir.2021.20100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to examine lesion characteristics influencing technical outcome and periprocedural peripheral embolization (PPE) during percutaneous mechanical rotational thrombectomy (PMT) of long femoropopliteal artery and bypass occlusions. METHODS Retrospectively, 65 consecutive patients (43 male patients, mean age 70±12 years; Rutherford category I-III), undergoing PMT (Rotarex®, Straub Medical AG) with acutely/subacutely occluded femoropopliteal arteries/bypasses were included. Occlusions (mean length, 217±98 mm) were treated by PMT followed by percutaneous transluminal angioplasty (PTA) plus drug-coated balloon or PTA plus stenting/stentgrafting. Technical success was defined as residual stenosis <30%. Follow-up included duplex ultrasound and ankle-brachial index (ABI) after 12 months. Endpoints were technical success, complications, improvement of Rutherford category, ABI, and patency (re-stenosis <50%). The influence of lesion length, duration, and thrombus density (measured in preinterventional computed tomography angiography) on technical success and PPE was analyzed. RESULTS Technical success was 18% (12/65) after PMT alone, 92% (60/65) after additional means. Four patients (6%) underwent bypass surgery and one patient (2%) amputation. PPE occurred in 11% (7/65). During the 12-month follow-up, three patients (5%) were lost to follow-up. ABI increased from baseline 0.5±0.12 to 0.81±0.14 (p = 0.001) and Rutherford category increased by at least one level in 57 patients at 12-month follow-up (clinical success, 88%). At 12 months, primary patency was 57.4% (95% CI, 45.8%-68.9%) and secondary patency was 75.0% (95% CI, 59.8%-72.3%). As risk factors for PPE, we identified lesion length >200 mm (15%; 6/39; OR 4.5; 95% CI, 0.5-40; p = 0.014) and thrombus density ≤45 HU (20%; 2/10; OR 3.0; 95% CI, 0.2-38.9; p = 0.05). No significant relation between risk factors and technical success was found. CONCLUSION PMT followed by PTA or implantation of stent (grafts) appears to be effective and safe for revascularization of acute/subacute long occlusions. Thrombus density <45 HU and lesion length above 20 cm represent risk factors for PPE during PMT.
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Affiliation(s)
- Erik Stahlberg
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Susanne Anton
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Malte Sieren
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Franz Wegner
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Joerg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Jan Peter Goltz
- Institute for Diagnostic and Interventional Radiology/Neuroradiology, SANA Hospital, Lübeck, Germany
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8
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Casale S, Bortolotto C, Stella GM, Filippi AR, Gitto S, Bottinelli OM, Carnevale S, Morbini P, Preda L. Recent advancement on PD-L1 expression quantification: the radiologist perspective on CT-guided FNAC. ACTA ACUST UNITED AC 2021; 27:214-218. [PMID: 33455898 DOI: 10.5152/dir.2021.19545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the feasibility, accuracy, and safety of Programmed Death-1/ Programmed Death-Ligand 1 (PD-1/ PD-L1) expression quantification in cytology cell-block samples obtained through transthoracic CT-guided fine-needle aspiration cytology (FNAC) from the interventional radiologist's perspective. METHODS We performed a consecutive unselected series of 361 CT-guided biopsies of pulmonary nodules and masses which came to our observation from June 2017 to October 2018. For each case, exhaustive clinical, morphologic, molecular and tomographic data were available. All the material obtained was fixed in formalin to obtain a cell-block for the pathologist, who performed immunohistochemical analysis to detect PD-L1 expression levels on each sample. RESULTS Of all the analyzed samples, 93.6% (338/361) were defined to be diagnostic, including neoplastic (72%, 260/361) and non-neoplastic lesions (21.6%, 78/361); only 6.4% (23/361) of them resulted in nondiagnostic specimens. Non-small cell lung cancer (NSCLC) accounted for 73.8% of neoplastic lesions (192/260): most of them were adenocarcinoma (83%, 160/192), followed by squamous carcinoma (14%, 27/192) and poorly differentiated carcinoma (3%, 5/192). In 96% of NSCLC (184/192), the diagnosis was reached either in the absence of complications or with early minor complications. PD-L1 expression was evaluated in all 192 NSCLC cytology specimens: 180 immunostainings were found to be adequate for PD-L1 testing. In 76% of cases, PD-L1 expression level was lower than 50%. CONCLUSION The findings of our study indicate that PD-L1 quantification using a cell-block approach on CT-guided FNAC is a feasible and safe technique and should be taken into account alongside with core biopsy approach, especially in case of advanced disease and/or fragile and older patients.
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Affiliation(s)
- Silvia Casale
- Radiology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | | | - Salvatore Gitto
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy
| | - Olivia Maria Bottinelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Radiology, University of Pavia, Pavia, Italy
| | - Sergio Carnevale
- Pathology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Patrizia Morbini
- Pathology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Preda
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Radiology, University of Pavia, Pavia, Italy
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Fluck F, Stephan M, Augustin A, Rickert N, Bley TA, Kickuth R. Percutaneous mechanical thrombectomy in acute and subacute lower-extremity ischemia: impact of adjunctive, solely nonthrombolytic endovascular procedures. Diagn Interv Radiol 2021; 27:206-213. [PMID: 33455896 DOI: 10.5152/dir.2021.19403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the role of adjunctive, solely nonthrombolytic endovascular therapy in treatment of acute lower-extremity ischemia by rotational percutaneous mechanical thrombectomy. METHODS A retrospective, single-center evaluation of 165 patients (167 limbs) that underwent rotational percutaneous mechanical thrombectomy between 2009 and 2016 was performed. RESULTS Rotational percutaneous mechanical thrombectomy was used as a single therapy in 9.0% (15 limbs), followed by percutaneous aspiration thrombectomy in 6.0% (10 limbs), percutaneous transluminal angioplasty in 19.8% (33 limbs) and stenting in 25.7% (43 limbs). Rotational percutaneous mechanical thrombectomy was followed by any combination of these three interventions in 39.5%. Clinical and technical success was documented in 92.2%, complications in 10.3% (n=17). No significant difference in clinical and technical success was observed using rotational percutaneous mechanical thrombectomy alone or with additional endovascular therapy. On a long-term basis, the re-ischemia-free survival was nearly twice as high as in previous studies that reported more cases treated by rotational percutaneous mechanical thrombectomy alone. CONCLUSION To assure a long-lasting primary patency after percutaneous mechanical thrombectomy, concomitant treatment of underlying lesions with adjunctive, nonthrombolytic endovascular methods should be considered.
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Affiliation(s)
- Friederika Fluck
- Department of Diagnostic and Interventional Radiology, University Medical Center Wuerzburg, Germany
| | - Maximilian Stephan
- Department of Diagnostic and Interventional Radiology, University Medical Center Wuerzburg, Germany
| | - Anne Augustin
- Department of Diagnostic and Interventional Radiology, University Medical Center Wuerzburg, Germany
| | - Nicole Rickert
- Department of Diagnostic and Interventional Radiology, University Medical Center Wuerzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Medical Center Wuerzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Medical Center Wuerzburg, Germany
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10
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Loffroy R, Falvo N, Galland C, Fréchier L, Ledan F, Midulla M, Chevallier O. Percutaneous Rotational Mechanical Atherectomy Plus Thrombectomy Using Rotarex S Device in Patients With Acute and Subacute Lower Limb Ischemia: A Review of Safety, Efficacy, and Outcomes. Front Cardiovasc Med 2020; 7:557420. [PMID: 33195452 PMCID: PMC7642033 DOI: 10.3389/fcvm.2020.557420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/24/2020] [Indexed: 01/14/2023] Open
Abstract
Acute and subacute ischemia of lower limbs is associated with high risk of amputation and potential severe life-threatening complications. Despite a lack of clear therapeutic recommendations, surgical treatments such as thrombectomy or bypass and/or catheter-directed thrombolysis (CDT) have been first-line procedures in both acute and subacute limb ischemia, but each therapy may lead to significant morbidity and mortality. Such situations demand fast restoration of appropriate flow to preclude limb loss and other complications. Percutaneous mechanical atherectomy plus thrombectomy (MATH) represents a minimally invasive approach for quickly recanalizing thrombus-containing lesions whatever the age of thrombus. Indeed, many chronic patients can present with critical limb ischemia, with thrombus-containing occlusive lesions triggered by underlying atherosclerotic disease. MATH offers various advantages over surgery and CDT, with lower invasiveness, faster recanalization, and the possibility to immediately treat the underlying lesions, with a lower rate of bleeding complications and no need for intensive care unit stay. Currently, several mechanical thrombectomy devices are offered as an alternative therapy and can be divided into pure rotational MATH systems and rheolytic thrombectomy devices. The only pure rotational MATH device currently available on the market is the Rotarex S device. We aimed to review contemporary clinical data regarding the safety, efficacy, and outcomes of MATH therapy using Rotarex S catheter in acute and subacute thrombus-containing arterial lesions of lower limbs. Future perspectives of Rotarex S MATH treatment and cost-effectiveness of its routine use will be also discussed.
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Affiliation(s)
- Romaric Loffroy
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Christophe Galland
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Léo Fréchier
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Frédérik Ledan
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- ImViA Laboratory-EA 7535, Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
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11
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Lichtenberg MKW. Evolving evidence for limb threatening ischemia treatment with a mechanical thrombectomy approach – we need to think endovascular. VASA 2020; 49:433-435. [DOI: 10.1024/0301-1526/a000907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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Yu HZ, Guo XB, Liu Z, Zhang Z, Feng H, Chen XM. Endovascular treatment of aortic saddle embolism through percutaneous mechanical Thrombectomy via Straub Rotarex catheter. J Cardiothorac Surg 2020; 15:278. [PMID: 32993712 PMCID: PMC7526190 DOI: 10.1186/s13019-020-01334-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To summarize our experience of endovascular treatment for abdominal aorta saddle embolism (ASE) through percutaneous mechanical thrombectomy (PMT). METHODS Clinical data of three ASE patients treated with an endovascular approach using percutaneous mechanical thrombectomy (PMT) were reviewed and analyzed. RESULTS After PMT, blood flow of limbs was restored in all of the three patients. However, two patients died from sudden cardiac arrest caused by hyperkalemia several hours after the procedure. The other one patient survived through continuous renal replacement therapy, which was initialized shortly after the surgical procedure. CONCLUSION Endovascular treatment through PMT can quickly restore blood flow in the ASE patients. Blood purification through renal replacement therapy is crucial to reduce mortality after restoring blood flow of the limbs.
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Affiliation(s)
- Hong-Zhi Yu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Xiao-Bo Guo
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Zhao Liu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Zhe Zhang
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Hai Feng
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Xue-Ming Chen
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China.
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13
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Wang Q, Zhu RM, Ren HL, Leng R, Zhang WD, Li CM. Combination of Percutaneous Rotational Thrombectomy and Drug-Coated Balloon for Treatment of Femoropopliteal Artery Nonembolic Occlusion: 12-Month Follow-up. J Vasc Interv Radiol 2020; 31:1661-1667. [PMID: 32921564 DOI: 10.1016/j.jvir.2020.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate safety and efficacy of percutaneous mechanical thrombectomy using the Rotarex catheter combined with drug-coated balloon (DCB) in treatment of femoropopliteal artery occlusive disease. MATERIALS AND METHODS Between January 2016 and February 2018, 81 patients with acute or subacute femoropopliteal artery occlusions were treated with the Rotarex catheter combined with DCB. Lesions were classified according to the onset of symptoms as acutely (< 14 d) or subacutely (14 d to 3 mo) occluded. The mean lesion length was 12.1 cm ± 6.7. The primary endpoint was target lesion patency at 1 year as evaluated by duplex ultrasound (peak systolic velocity ratio < 2.4) and freedom from clinically indicated target lesion revascularization. Amputation rate, major adverse events, and ankle-brachial index at 12 months were evaluated. RESULTS Technical success rate was 100% (n = 81). Bailout stents were necessary in 14 patients owing to residual stenosis or flow-limiting dissection. Additional thrombolysis was applied in 10 interventions. No major adverse events occurred during hospital stay. There were 9 restenosis cases during the 12-month follow-up period. Primary patency rate was 87.3% (62/71), and freedom from target lesion revascularization rate was 90.1% (64/71). Ankle-brachial index significantly increased from 0.46 ± 0.15 to 0.77 ± 0.14 during follow-up. The amputation rate was 1.4% at 12 months. CONCLUSIONS These initial data from 2 centers suggest that the combination of the Rotarex catheter and DCB may be safe and effective for treatment of acute or subacute thrombotic femoropopliteal occlusion with superior immediate and midterm results achieved.
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Affiliation(s)
- Qi Wang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Beijing 100020, China
| | - Ren-Ming Zhu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Beijing 100020, China
| | - Rui Leng
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Beijing 100020, China
| | - Wang-De Zhang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Beijing 100020, China
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Beijing 100020, China.
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Elbadawy A, Hasaballah A. Hybrid Treatment for Ischemic Limb Salvage in Patients with Subacute Complex Infrainguinal Arterial Occlusions. Indian J Surg 2020. [DOI: 10.1007/s12262-019-02002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Lichtenberg MKW. Evolving Evidence for Acute and Subacute Limb Ischemia Treatment With a Purely Mechanical Thrombectomy Approach. J Endovasc Ther 2019; 26:302-304. [PMID: 30957618 DOI: 10.1177/1526602819841147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Bulvas M, Sommerová Z, Vaněk I, Weiss J. Prospective Single-Arm Trial of Endovascular Mechanical Debulking as Initial Therapy in Patients With Acute and Subacute Lower Limb Ischemia: One-Year Outcomes. J Endovasc Ther 2019; 26:291-301. [PMID: 30955402 PMCID: PMC6537139 DOI: 10.1177/1526602819840697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose: To report the results of a prospective, single-arm study to
establish whether the initial treatment of acute or subacute limb ischemia (ALI
and SLI, respectively) can be accomplished successfully using endovascular
mechanical debulking of the target vessels to avoid the risks associated with
thrombolysis and/or open surgery. Materials and Methods: From April
2009 to April 2015, 316 consecutive patients (mean age 70.9±12 years; 184 men)
with ALI (202, 63.9%) or SLI (114, 36.1%) were enrolled; the only exclusion
criterion was irreversible ischemia. The ALI group included 146 (72.3%)
participants with category IIb ischemia and 56 (27.7%) with category IIa.
Critical limb ischemia was diagnosed in 74 (64.9%) of the 114 patients with SLI.
Target occlusions of thrombotic (n=256) or embolic (n=60) origin were located in
the femoropopliteal segment (n=231), prosthetic or venous femoropopliteal bypass
grafts (n=75), and the aortoiliac segment (n=35). The mean occlusion length was
22.9±14.8 cm. Results: The overall technical success (residual
stenosis ≤30%) was 100% after debulking and adjunctive techniques (aspiration,
dilation, stenting) at the level of the target lesions. No open surgical or
thrombolytic modalities were necessary to bypass or recanalize the target
vessels, and no death occurred in association with target occlusion therapy.
Additional infrapopliteal interventions were performed in 195 (61.7%) patients
(adjunctive thrombolysis in 29) to treat acute, subacute, and chronic lesions.
Minor complications directly related to the debulking procedure occurred in 26
(8.2%) patients. Serious complications occurred in 11 (3.5%) patients, including
hemorrhage in 8 (2.5%) patients (associated with infrapopliteal thrombolysis in
5). At 30 days, primary and secondary patency rates were 94.3% and 97.2%,
respectively; mortality was 0.3% (1 fatal intracranial hemorrhage after
adjunctive thrombolysis). Of 229 patients eligible for 1-year follow-up,
amputation-free survival was estimated to be 87.4% in 199 patients with
available data. Conclusion: In this all-comers study, mechanical
debulking with the Rotarex alone or with adjunctive techniques is feasible as a
primary therapy for occluded supratibial vessels in patients with ALI or
SLI.
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Affiliation(s)
- Miroslav Bulvas
- 1 Cardiocenter, Third Faculty of Medicine, Charles University, and Department of Surgery, Division of Interventional Angiology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Zuzana Sommerová
- 2 Department of Internal Medicine 2, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Ivan Vaněk
- 1 Cardiocenter, Third Faculty of Medicine, Charles University, and Department of Surgery, Division of Interventional Angiology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Jiří Weiss
- 1 Cardiocenter, Third Faculty of Medicine, Charles University, and Department of Surgery, Division of Interventional Angiology, University Hospital Královské Vinohrady, Prague, Czech Republic
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Vorwerk D, Triebe S, Ziegler S, Ruppert V. Percutaneous Mechanical Thromboembolectomy in Acute Lower Limb Ischemia. Cardiovasc Intervent Radiol 2018; 42:178-185. [DOI: 10.1007/s00270-018-2129-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/19/2018] [Indexed: 11/30/2022]
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18
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Liu J, Li T, Huang W, Zhao N, Liu H, Zhao H, Wang H. Percutaneous mechanical thrombectomy using Rotarex catheter in peripheral artery occlusion diseases - Experience from a single center. Vascular 2018; 27:199-203. [PMID: 30458685 DOI: 10.1177/1708538118813239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS The aim of this retrospective single-center study was to analyze the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of peripheral artery occlusion. METHODS In this study, we identified a total of 42 patients who underwent mechanical thrombectomy using Rotarex catheter at our institution. Procedural outcomes and complications were evaluated. RESULTS The cohort consisted of 42 patients (31 men and 11 women), aged 32-93 years (median 68 years). The number of external iliac artery occlusion was 5, with common femoral artery 5, superficial femoral artery 28, femoral profound artery 2, popliteal artery 12, and brachial artery 2. The causes of occlusion were thrombosis (29 cases, 69%), embolism (6 cases, 14%), and reocclusion after percutaneous intervention (7 cases, 17%). We achieved primary success in 100% of the patients with mechanical thrombectomy, associated with balloon angioplasty (40/42, 95.2%) and stent deployment (16/42, 38.1%). The median time of the interventional procedure was 145 min. We encountered lower percentage of distal embolization (2.4%) and artery dissection (2.4%) during usage of Rotarex catheter in our cohort. CONCLUSIONS Rotarex thrombectomy was a useful tool to recanalize occluded vessels with additional treatment such as balloon angioplasty or stent deployment, with a low rate of failures and complications. And prospective studies in this issue are recommended.
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Affiliation(s)
- Jinbo Liu
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
| | - Tianrun Li
- 2 Department of Interventional vascular surgery, Peking University Third Hospital, Beijing, P. R. China
| | - Wei Huang
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
| | - Na Zhao
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
| | - Huan Liu
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
| | - Hongwei Zhao
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
| | - Hongyu Wang
- 1 Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. China
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Giusca S, Raupp D, Dreyer D, Eisenbach C, Korosoglou G. Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries. World J Cardiol 2018; 10:145-152. [PMID: 30386492 PMCID: PMC6205845 DOI: 10.4330/wjc.v10.i10.145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/07/2018] [Accepted: 08/11/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the efficacy and safety of the 6 French (6F) Rotarex®S catheter system in patients with acute limb ischemia (ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.
METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex®S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and follow-up from these patients were further used for analysis.
RESULTS Two patients (29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex®S catheter. Additional Rotarex®S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases (29%), in the tibiofibular tract and posterior tibial artery in two of seven cases (29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases (43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.
CONCLUSION Mechanical debulking using the 6F Rotarex®S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Dorothea Raupp
- Department of Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Dirk Dreyer
- Straub Medical AG, Wangs CH-7323, Switzerland
| | - Christoph Eisenbach
- Department of Gastroenterology and Diabetology, GRN Hospital Weinheim, Weinheim 69469, Germany
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim 69469, Germany
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20
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Stanek F, Ouhrabkova R, Prochazka D. Could mechanical thrombectomy replace thrombolysis in the treatment of acute and subacute limb ischemia? Minerva Cardioangiol 2018; 67:234-245. [PMID: 30160083 DOI: 10.23736/s0026-4725.18.04770-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Acute limb ischemia is a vascular emergency defined as a sudden decrease in limb perfusion associated with a risk of loss of viability of the affected extremity. Surgical treatment (Fogarty thromboembolectomy) is indicated only in suprainguinal occlusions. Other cases of acute and subacute limb ischemia should be managed percutaneously. Catheter-based treatment involves local thrombolysis and percutaneous mechanical thrombectomy (PMT). There are several devices in use for PMT; of them, the Rotarex system appears to be the most useful. There are no randomized studies comparing thrombolysis and PMT. Only indirect comparison is possible. The immediate and long-term results of PMT using the Rotarex device are probably more favorable than those following thrombolysis. Particularly for older and polymorbid patients, it may be significant that PMT, in comparison with thrombolysis, can restore blood flow faster and in one session; no contraindications for PMT in contrast to potentially life-threatening complications in thrombolysis exist, and there is also no need for observation in intensive care unit after PMT. Hospital stay after PMT is shorter. There is only one exception when thrombolysis cannot be replaced by Rotarex PMT - in the case of crural arteries involvement - due to the catheter size. In our opinion, PMT is superior to thrombolysis in the treatment of acute and subacute limb ischemia. Thrombolysis should be considered only in special cases, e.g. in crural arteries occlusions or in failure of mechanical thrombectomy.
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Affiliation(s)
- Frantisek Stanek
- Department of Cardiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic - .,Department of Radiology, District Hospital Kladno, Kladno, Czech Republic -
| | | | - David Prochazka
- Department of Radiology, District Hospital Kladno, Kladno, Czech Republic
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21
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Nagato H, Toma M, Yoshizawa K, Ohno N, Yoshikawa E. A Simple Reproducible Method to Treat Acute or Subacute Arterial Obstruction When the Thrombus Is Adherent to the Arterial Wall. Ann Vasc Dis 2017. [PMID: 29515710 PMCID: PMC5835427 DOI: 10.3400/avd.cr.17-00058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report three consecutive patients with limb ischemia, where symptoms appeared several days to weeks prior to presentation. In all cases, initial over-the-wire thrombectomy failed due to adherence of the thrombus to the arterial wall. We adopted a new approach of stretching the whole obstructed segment by a series of ballooning using a percutaneous transluminal angioplasty (PTA) catheter. A subsequent thrombectomy was successful in all three cases. No further intervention, such as stenting or bypass surgery, was required. The adhering thrombus was dissected by stretching the arterial wall at the site of obstruction.
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Affiliation(s)
- Hisao Nagato
- Department of Cardiovascular Surgery, Kinki University Nara Hospital, Ikoma, Nara, Japan
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Kousuke Yoshizawa
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Eiji Yoshikawa
- Department of Cardiovascular Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
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22
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Heller S, Lubanda JC, 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 RESEARCH INTERNATIONAL 2017; 2017:2362769. [PMID: 28555191 PMCID: PMC5438831 DOI: 10.1155/2017/2362769] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/05/2017] [Accepted: 04/16/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. METHODS In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis. Additional fibrinolysis and adjunctive aspirational thrombectomy were utilized for outflow occlusion when required. Procedural outcomes, amputation rate, and mortality at 30 days were evaluated. RESULTS Of the 147 patients treated with mechanical thrombectomy, Rotarex S was used as first-line treatment in 120 cases and as second-line treatment in 27 cases. Overall, we achieved 90.5% procedural revascularization success rate when combining mechanical thrombectomy with limited thrombolysis for severe outflow obstruction, and 1 death and 3 amputations were observed. We achieved primary success in 68.7% of the patients with the mechanical thrombectomy only, and in 21.8% of the patients, we successfully used additional limited thrombolysis in the outflow. The overall mortality was 0.7% and amputation rate was 2% at 30 days. CONCLUSION Percutaneous mechanical thrombectomy as first-line mini-invasive treatment in infrainguinal ALI is safe, quick, and effective, and the performance outcomes can be superior to that of traditional surgical embolectomy.
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Affiliation(s)
- Samuel Heller
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jean-Claude Lubanda
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Varejka
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Miroslav Chochola
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavel Prochazka
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - David Rucka
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Sylvie Kuchynkova
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Johana Horakova
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Freitas B, Steiner S, Bausback Y, Branzan D, Ülrich M, Bräunlich S, Schmidt A, Scheinert D. Rotarex Mechanical Debulking in Acute and Subacute Arterial Lesions. Angiology 2016; 68:233-241. [DOI: 10.1177/0003319716646682] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Data regarding the effectiveness and safety of percutaneous mechanical thrombectomy (PMT) in contemporary routine care are scarce. Materials and Methods: Consecutive patients undergoing PMT of native lower limb acutely/subacutely occluded arteries were included. Results: In all, 525 consecutive patients were available for analysis with a mean age of 66.7 ± 10.7 years. Almost two-third (n = 324; 61.7%) were men with acutely (n = 211; 40.2%) or subacutely (n = 314; 59.8%) occluded lesions presenting mostly in Rutherford-Becker category (RBC): 3 (30.3%) and 4 (47.6%). Mean lesion length was 159 mm (range 22-279 mm), with moderate and severe calcification in 119 (23.3%) lesions. PMT was performed solely in 161(27.2%), PMT + balloon angioplasty in 232 (39.1%), provisional stenting in 169 (28.4%), and thrombolysis in 77 (13.9%) interventions. Procedural technical success rate was 97.7%, with improvement in RBC persisting in 74.1% of patients after 12 ± 2.4 months mean time follow-up. Overall 30 days major adverse events (MAEs) was 6.9% with a mortality rate of 1.1%. No death was directly related to the device. After 12 months, a promising overall target lesion revascularization (TLR; 10.1%), non-TLR (6.6%), and major amputation rates (2.3%) were found. One-year mortality was 8%. Conclusion: Treatment with PMT resulted in clinic and hemodynamic improvement in the majority of patients, thereby reducing the need for thrombolysis in a significant proportion of patients. Prospective studies in this issue are recommended.
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Affiliation(s)
- Bruno Freitas
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
- Universidade Federal do Vale do Sao Francisco, Petrolina, Brazil
| | - Sabine Steiner
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Yvonne Bausback
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Daniela Branzan
- Department of Vascular Surgery, University Hospital, University of Leipzig, Leipzig, Germany
| | - Matthias Ülrich
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Sven Bräunlich
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Andrej Schmidt
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Dierk Scheinert
- Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany
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24
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Giusca S, Eisele T, Raupp D, Eisenbach C, Korosoglou G. Successful carbon dioxide angiography guided endovascular thrombectomy of the superficial femoral artery in a young patient with critical limb ischemia. Heart Vessels 2016; 32:359-363. [PMID: 27663555 DOI: 10.1007/s00380-016-0894-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/16/2016] [Indexed: 12/19/2022]
Abstract
Currently, the treatment of thromboembolic ischemia of the lower extremities includes percutaneous rotational thrombectomy and aspiration devices. However, the standard approach for endovascular treatment requires the administration of iodine contrast agents, which is problematic in patients with pre-existing renal disease and diabetes. Herein, we describe a case of a CO2 angiography guided endovascular thrombectomy of the superficial femoral artery (SFA) in a young patient with critical limb ischemia. Mechanical thrombectomy using the Rotarex system, catheter aided aspiration and subsequent stent placement in the SFA was entirely guided using CO2 angiography.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
| | - Tom Eisele
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany
| | - Dorothea Raupp
- Department of Gastroenterology and Diabetology, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany
| | - Christoph Eisenbach
- Department of Gastroenterology and Diabetology, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
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Abstract
Considerable advances have been made over the last decade in percutaneous technology for the treatment of atherosclerotic diseases in the femoro-popliteal arteries. While treatment strategies are well defined in the iliac segment, where angioplasty and stenting perform well in appropriately selected lesions, the search for a durable transcatheter therapy for femoro-popliteal lesions continues. Whereas balloon angioplasty (PTA) is the accepted therapy for short lesions, long diffuse lesions are still recommended for surgical treatment. However, attractive new technologies ranging from transcatheter plaque excision to laser ablation, rotational atherectomy, cryoplasty, brachytherapy, and placement of drug-eluting stents to simple angioplasty with drug-coated balloons may have the potential to replace femoro-popliteal bypass surgery as a treatment of choice for complex lesions. This article reviews the status of percutaneous endovascular techniques for the treatment of femoro-popliteal artery occlusive disease.
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Affiliation(s)
- Thomas Zeller
- Albert-Ludwigs-University Freiburg, Freiburg, Germany.
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26
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Sakes A, Regar E, Dankelman J, Breedveld P. Treating Total Occlusions: Applying Force for Recanalization. IEEE Rev Biomed Eng 2016; 9:192-207. [DOI: 10.1109/rbme.2016.2580218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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27
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Combined treatment of subacute and acute synthetic and venous bypass-graft occlusions with percutaneous mechanical thrombectomy and thrombolysis. Eur J Radiol 2013; 82:e807-15. [DOI: 10.1016/j.ejrad.2013.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/24/2013] [Accepted: 08/05/2013] [Indexed: 11/19/2022]
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Dys K, Drelichowska-Durawa J, Dołega-Kozierowski B, Lis M, Sokratous K, Iwanowski W, Drelichowski S, Witkiewicz W. Mechanical thrombectomy using Rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture - a case report and literature review. Pol J Radiol 2013; 78:74-9. [PMID: 24115965 PMCID: PMC3789939 DOI: 10.12659/pjr.889245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/16/2013] [Indexed: 11/09/2022] Open
Abstract
Background: Treatment of peripheral arterial diseases may be distinguished into conservative and interventional management; the latter is divided into surgical and endovascular procedures. Management of peripheral artery stenosis and occlusion with vascular stents is associated with the risk of late complications such as restenosis, stent fracture or dislocation. Case Report: A 62-year-old woman with generalized atherosclerosis, particularly extensive in lower limb arteries, was admitted to the Department of Angiology 11 months after having an endovascular procedure performed due to critical ischemia of left lower limb. Because of stent occlusion, a decision to perform angiographic examination of lower limb arteries was made. Examination revealed occlusion of the superficial femoral artery along its entire length, including previously implanted stents. Distal stent was fractured with slight dislocation of the proximal segment. A decision was made to perform mechanical thrombectomy using a Rotarex system followed by a stent-in-stent placement procedure. Follow-up angiography and ultrasound scan performed 24 hours after the procedure revealed a patent vessel with satisfactory blood flow. Discussion: Nowadays, imaging diagnostics of peripheral artery stenosis involves non-invasive examinations such as ultrasound, minimally invasive examinations such as angio-MRI and MDCT, or invasive examinations such as DSA and IVUS. DSA examinations are used to confirm significant stenosis or occlusion of a vessel, particularly when qualifying a patient for endovascular treatment. Due to their anatomic location, the superficial femoral artery and the popliteal artery are subject to various forces e.g. those exerted by the working muscles. Mechanical thrombectomy and atherectomy are efficient methods of arterial recanalization used in the treatment of acute, subacute or even chronic occlusions or stenosis of peripheral vessels. Conclusions: Frequency of angioplasty and vascular stent implantation procedures is increased in patients with peripheral arterial disease, thus increasing the incidence of reported early and late complications such as acute stent thrombosis, restenosis and stent fractures. The Rotarex transcutaneous mechanical thrombectomy system is an efficient method of treating occlusions in arterial stents. It is also safe when performed by experienced operators.
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Affiliation(s)
- Krzysztof Dys
- Lower Silesian Diagnostic Imaging Centre, Regional Specialist Hospital in Wrocław, Research and Development Centre, Wrocław, Poland ; Wrovasc - Integrated Cardiovascular Centre, Wrocław, Poland
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Lichtenberg M, Stahlhoff FW, Boese D. Endovascular treatment of acute limb ischemia and proximal deep vein thrombosis using rotational thrombectomy: A review of published literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:343-8. [PMID: 24060441 DOI: 10.1016/j.carrev.2013.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/02/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
Acute and subacute ischemia of the lower extremity is still a common reason for amputation. The treatment of this condition includes the well known procedure of local thrombolysis, surgical thrombectomy and, in recent times, percutaneous mechanical thrombectomy procedures such as rotational thrombectomy. However, in randomized studies Fogarty's procedure of surgical thrombectomy was associated with a high rate of perioperative complications and, in part, low technical success rates. On the other hand, local thrombolysis is associated with hemorrhage as well as high costs because of measures requiring substantial resources, such as intensive care monitoring or repeat angiographies. In several studies, the endovascular therapy options of Straub Rotarex® and Aspirex® systems, both products of technical advancements in the field, were shown to be successful in terms of amputation-free survival. Their use was also associated with low complication rates. The majority of studies were focused on arterial blood flow in the femur. However, in the meantime several registers and studies have shown that the systems can also be effectively used to treat proximal deep vein thrombosis. In the present report we review the current study-based value of rotational thrombectomy in the venous and arterial system.
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Mechanical thrombectomy in proximal subclavian artery in-stent occlusion. Cardiovasc Interv Ther 2013; 29:140-5. [PMID: 23943249 DOI: 10.1007/s12928-013-0199-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Mechanical thrombectomy is an established tool for endovascular therapy of acute/chronic in-stent occlusions of the lower extremities, especially for the superficial femoral artery. The authors report the use of the Rotarex catheter system for an in-stent proximal subclavian occlusion. CASE PRESENTATION A 51-year-old female patient with previous multiple attempts at left subclavian revascularization; primary endovascular stenting at the origin of the subclavian artery occluded at 3 months, and a carotid-subclavian bypass was placed distally to the stent. After 6 months from the first treatment, the patient was readmitted with an acute left arm ischemia and full occlusion of the bypass was confirmed at computed tomography angiography. An anterograde thrombectomy for in-stent restenosis, together with PTA with a drug-eluting balloon was performed in the subclavian artery with confirmed patency at 6 months. CONCLUSION Mechanical thrombectomy together with drug-eluting balloon PTA for in-stent occlusion or restenosis of the subclavian artery could be a promising procedure with a lower invasivity and risk with respect to surgical options.
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Mechanical thrombectomy of iliac vein thrombosis in a pig model using the Rotarex and Aspirex catheters. Cardiovasc Intervent Radiol 2013; 37:211-7. [PMID: 23748731 DOI: 10.1007/s00270-013-0661-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the efficacy and safety of mechanical thrombectomy for iliac vein thrombosis using Rotarex and Aspirex catheters in a pig model. MATERIALS AND METHODS Iliac vein thrombosis was induced in six pigs by means of an occlusion-balloon catheter and thrombin injection. The presence of thrombi was verified by digital subtraction angiography (DSA) and computed tomography (CT). Thrombectomy was performed using 6F and 8F Rotarex and 6F, 8F, and 10F Aspirex catheters (Straub Medical AG, Wangs, Switzerland). After intervention, DSA and CT were repeated to evaluate the efficacy of mechanical thrombectomy and to exclude local complications. In addition, pulmonary CT was performed to rule out pulmonary embolism. Finally, all pigs were killed, and iliac veins were dissected to perform macroscopic and histological examination. RESULTS Thrombus induction was successfully achieved in all animals as verified by DSA and CT. Subsequent thrombectomy lead to incomplete recanalization of the iliac veins with residual thrombi in all cases. However, the use of the 6F and 8F Rotarex catheters caused vessel perforation and retroperitoneal hemorrhage in all cases. Application of the Aspirex device caused one small transmural perforation in a vessel treated with a 10F Aspirex catheter, and this was only seen microscopically. Pulmonary embolism was detected in one animal treated with the Rotarex catheters, whereas no pulmonary emboli were seen in animals treated with the Aspirex catheters. CONCLUSION The Aspirex catheter allowed subtotal and safe recanalization of iliac vein thrombosis. In contrast, the use of the Rotarex catheter caused macroscopically obvious vessel perforations in all cases.
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Lichtenberg M, Stahlhoff W, Boese D, Hailer B. Twelve months outcome after percutaneous mechanical thrombectomy for treatment of acute femoropopliteal bypass occlusion. Cardiovasc Interv Ther 2012; 28:178-83. [PMID: 23242521 DOI: 10.1007/s12928-012-0152-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/29/2012] [Indexed: 11/30/2022]
Abstract
Acute and subacute ischemia of the legs in acute and subacute femoropopliteal bypass occlusion is a dramatic situation that endangers the survival of the limbs, depending on the severity of the ischemia. Different therapy options like percutaneous mechanical thrombectomy procedures, which include rotational thrombectomy, have become available in recent years in addition to local lysis and surgical thrombectomy. Rotational thrombectomy with the Straub Rotarex(®) System as an endovascular therapy option has demonstrated promising results leading to amputation-free survival in multiple studies. We recently provided data of 22 patients with acute femoropopliteal bypass occlusion where we examined the feasibility of the Rotarex(®) System in this indication. A technical success rate of 82% was demonstrated. During a follow-up period of 6 months, no reinterventions in these patients had to be performed. We now provide patency rates in 21 patients of our study group after a follow-up period of 12 months. The average ABI after 12 months was 0.80 ± 0.1. One patient showed a hemodynamic restenosis in a Nitinolstent distal to the femoropopliteal bypass which was implanted in the index procedure. No reocclusion of the femoropopliteal bypasses occurred in all patients.
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Affiliation(s)
- Michael Lichtenberg
- Cardiovascular Clinic, Vascular Center, Katholisches Klinikum Essen, Essen, Germany.
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33
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Recanalization of acute and subacute venous and synthetic bypass-graft occlusions with a mechanical rotational catheter. Cardiovasc Intervent Radiol 2012; 36:936-42. [PMID: 23152037 DOI: 10.1007/s00270-012-0507-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/29/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Percutaneous mechanical thrombectomy (PMT) is now established as an alternative treatment of acute arterial occlusions in addition to fibrinolysis and surgical thrombectomy. The objective of this retrospective study was the investigation of a rotational atherothrombectomy catheter in terms of safety and efficacy in the treatment of acute and subacute femoropopliteal bypass occlusions. MATERIALS AND METHODS Forty-two patients (average age 65.8 ± 9.1 years) with acute (<14 days [n = 31]) and subacute (14-42 days [n = 11]) femoropopliteal bypass occlusions were treated consecutively with a rotational debulking and removal catheter (Straub Rotarex). The average occlusion length was 28.4 ± 2.9 (24-34) cm. Thirty-four (81%) patients underwent venous bypass, and 8 (19%) patients underwent polytetrafluoroethylene bypass. RESULTS The technical success rate was 97.6% (41 of 42). In 1 patient, blood flow could not be restored despite the use of the atherothrombectomy system. The average catheter intervention time was 6.9 ± 2.1 (4-9) min. Ankle-brachial index increased from 0.39 ± 0.13 to 0.83 ± 0.11 at discharge and to 0.82 ± 0.17 after 1 month (p < 0.05). There were a total of 2 (4.8%) peri-interventional complications: One patient developed a distal embolism, which was successfully treated with local lysis, and another patient had a small perforation at the distal anastomosis, which was successfully treated with a stent. CONCLUSION PMT with the Rotarex atherothrombectomy catheter represents a safe and effective option in the treatment of acute and subacute femoropopliteal bypass occlusions because it can quickly restore blood flow.
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34
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Lichtenberg M, Käunicke M, Hailer B. Percutaneous mechanical thrombectomy for treatment of acute femoropopliteal bypass occlusion. Vasc Health Risk Manag 2012; 8:283-9. [PMID: 22661895 PMCID: PMC3363147 DOI: 10.2147/vhrm.s30819] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Acute and subacute ischemia of the legs in acute and subacute femoropopliteal bypass occlusion is a dramatic situation that endangers the survival of the limbs, depending on the severity of the ischemia. Different therapy options like percutaneous mechanical thrombectomy procedures, which include rotational thrombectomy, have become available in recent years, in addition to local lysis and surgical thrombectomy. Surgical thrombectomy using the Fogarty catheter technique, in particular, shows an increased incidence of perioperative complications but only small technical success rates in randomized trials. On the other hand, local lysis is associated with increased costs due to resource-consuming measures, such as intensive monitoring and repeat angiographies, in addition to bleeding complications. In the past, further development of the Straub Rotarex® system as an endovascular therapy option has demonstrated good success leading to amputation-free survival in multiple studies. At the same time, a low rate of complications with use has been documented. Most examinations have been conducted in the thigh. To date, there are little investigational data on its use in acutely and subacutely occluded femoropopliteal bypasses. In this paper, the current study-based significance of the Rotarex system for this indication is analyzed based on the existing literature and the authors’ own experiences with 22 patients.
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Affiliation(s)
- Michael Lichtenberg
- Cardiovascular Clinic, Vascular Center, Katholisches Klinikum Essen, Germany.
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35
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Karnabatidis D, Spiliopoulos S, Tsetis D, Siablis D. Quality improvement guidelines for percutaneous catheter-directed intra-arterial thrombolysis and mechanical thrombectomy for acute lower-limb ischemia. Cardiovasc Intervent Radiol 2011; 34:1123-36. [PMID: 21882081 DOI: 10.1007/s00270-011-0258-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 07/27/2011] [Indexed: 02/08/2023]
Abstract
Percutaneous catheter-directed intra-arterial thrombolysis is a safe and effective method of treating acute and subacute lower limb ischemia, as long as accurate patient selection and procedural monitoring are ensured. Although larger, controlled trials are needed to establish the role of PTDs in ALI, mechanical thrombectomy could currently be applied combined with lytic infusion in selected cases where rapid recanalization is required or as a stand-alone therapy when the administration of thrombolytic agents is contraindicated.
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Affiliation(s)
- Dimitris Karnabatidis
- Department of Radiology, Patras University Hospital, School of Medicine, Rion, Greece.
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36
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Laganà D, Carrafiello G, Lumia D, Fontana F, Mangini M, Vizzari FA, Piffaretti G, Fugazzola C. Recanalisation of thrombotic arterial occlusions with rotational thrombectomy. LA RADIOLOGIA MEDICA 2010; 116:932-44. [PMID: 21311991 DOI: 10.1007/s11547-010-0611-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Accepted: 03/26/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE This study sought to assess the effectiveness of rotational thrombectomy (RT) with the Rotarex device in the treatment of thrombotic occlusions in native arteries, by-pass grafts, stents and stent-grafts. MATERIALS AND METHODS Over the last 4 years, 22 patients (14 men and 8 women; mean age 62.6 years) affected by 5 acute (<14 days) thrombotic occlusions of the native arteries (4 plaque thromboses in the common iliac artery and one on a dissection intimal flap of the external iliac artery), 17 subacute and chronic thromboses affecting 4 femoro-popliteal by-pass grafts, 10 stents (7 in the common iliac artery and 3 in the superficial femoral artery) and 3 stents-grafts were studied. Acute thromboses of native arteries were follow-up with colour-Doppler ultrasound (US) examination at 1 and 3 months. Subacute and chronic thrombotic occlusions were follow-up with colour-Doppler US examination at 1, 3, 6 and 12 months and yearly thereafter. RESULTS Immediate technical success was achieved without any need for additional procedures in all acute occlusions of native arteries (4/22 cases). In the subacute and chronic occlusions, the procedure was completed with percutaneous transluminal angioplasty (PTA) (8/22), cutting balloon (6/22) and stenting (5/22). The complication rate was 4.8% (1 rupture of the external iliac artery repaired with a stent-graft). CONCLUSIONS Arterial recanalisation with RT is the treatment of choice for acute thrombosis of healthy native arteries (4-7 mm); the treatment of thrombosis complicating calcified plaques or dissection intimal flaps may cause rupture of the arterial wall. In subacute and chronic occlusions of by-pass grafts, stents and stent grafts, additional procedures are necessary to achieve complete recanalisation.
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Affiliation(s)
- D Laganà
- Department of Radiology, University of Insubria, V.le Borri 57, Varese, Italy.
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37
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Perkutane mechanische Thrombektomie mittels Rotationsthrombektomie Aktuelle Studienlage. ACTA ACUST UNITED AC 2010; 105:705-10. [DOI: 10.1007/s00063-010-1122-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 07/25/2010] [Indexed: 12/28/2022]
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Massive pulmonary embolism: treatment with the rotarex thrombectomy system. Cardiovasc Intervent Radiol 2010; 34:106-13. [PMID: 20454793 DOI: 10.1007/s00270-010-9878-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Accepted: 04/15/2010] [Indexed: 12/16/2022]
Abstract
This study was designed to evaluate the efficacy and safety of percutaneous mechanical thrombectomy (PMT) for acute massive pulmonary embolism (PE). Fourteen patients (8 men, 6 women) with a mean age of 55.4 (range, 38-71) years with acute massive PE were initially diagnosed by computed tomography (CT) and confirmed by pulmonary angiography. All patients presented with acute PE symptoms and hemodynamic compromise. Each patient was treated with Straub Rotarex thrombectomy device and five patients received additional thrombolysis. Technique success and clinical improvement were achieved in all patients without major complications. The mean pulmonary artery pressure (PAP) decreased from 37.6 ± 6.6 to 29 ± 6.4 mmHg (P < 0.01) after PMT. Partial arterial pressures of O(2) (PaO(2)) increased from 61.1 ± 9.2 to 88 ± 5.1 mmHg (P < 0.01). The Miller index was 0.67 ± 0.11 and 0.37 ± 0.13 (P < 0.01), respectively, before and after PMT (P < 0.01). Eleven patients had no recurrence of PE on a mean follow-up of 28.3 months, whereas the other three patients were lost to follow-up. The preliminary experience in our series suggests that the Straub Rotarex thrombectomy device, which has been utilized in peripheral arteries, also is useful for the treatment of acute massive PE.
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Kobayashi T, Funatsu A, Ejima E, Muranishi H, Utsunomiya M, Shibata K, Mizobuchi M, Enjoji Y, Nakamura S. The results of a new distal protection method in intervention for chronic total occlusion of the superficial femoral artery. Cardiol Res Pract 2009; 2009:687609. [PMID: 19946634 PMCID: PMC2778189 DOI: 10.4061/2009/687609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 07/16/2009] [Indexed: 12/04/2022] Open
Abstract
Aims. To determine the efficacy of a new distal protection method in SFA CTO interventions.
Methods and Results. From June
2003 to February 2009, ninety-two consecutive,
chronic total occlusions of superficial femoral
arteries were treated with catheter-based
intervention using a bidirectional approach.
Nine of these cases were managed with our
original, distal protection method, based on
symptoms, angiographic images, wire resistance,
and intravascular ultrasound images. The average
age was 73 years; eight patients were male. The
mean occlusion length was 17.1 cm. A
distal protection balloon was inserted from the
retrograde sheath in the popliteal artery and
placed distal to the occluded lesion after
successful wire crossing. Lesion dilatation with
a balloon was performed antegradely and debris
was removed by 6Fr. guiding catheter. Debris was
retrieved from all lesions, consisting mainly of
thrombus. Where we decided not to use the distal
protection method, there was no distal
thromboembolism. Conclusion. In
SFA-CTO intervention, the risk of distal
embolization is 10%, which can be
anticipated and eliminated by the distal
protection method.
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Affiliation(s)
- Tomoko Kobayashi
- Cardiovascular Center, Kyoto Katsura Hospital, 17 Yamada-Hirao, Nishikyo-ku, Kyoto 615-8256, Japan
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Treitl M, Strube H, Helmberger T, Reiser M. [Peripheral arterial disease. Diagnosis and therapy according to current guidelines]. Radiologe 2009; 48:1022-8, 1030-1. [PMID: 18806988 DOI: 10.1007/s00117-008-1705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Guidelines conduce to establish consistent standards of therapy and contribute to the orientation and safeguard of the attending physician. Peripheral arterial disease (PAD) may be classified according to its stage as intermittent claudication, chronic critical limb ischemia or acute limb ischemia. Since these diseases are common and life-threatening, current guidelines are of major interest for the attending physician, not least because of forensic reasons. This overview describes the current principles of diagnosis and therapy as well as recent developments in peripheral endovascular intervention. Current national and international guidelines, particularly the Transatlantic Intersociety Consensus (TASC), were taken into account.
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Affiliation(s)
- M Treitl
- Institut für Klinische Radiologie, Poliklinik, Klinikum Innenstadt der Ludwig-Maximilians-Universität München, München, Deutschland.
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Salazar GM, Faintuch S, Gladstone SR, Lang EV. In vitro analysis of downstream particulates with mechanical thrombectomy devices: comparison of 20-kHz sonothrombolytic and rotating dispersion wire systems. J Vasc Interv Radiol 2009; 20:634-9. [PMID: 19324573 DOI: 10.1016/j.jvir.2008.12.416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 12/17/2008] [Accepted: 12/18/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To assess the potential of macroembolization, the authors compared the downstream particulate profile generated with use of two thrombectomy devices, a 20-kHz ultrasound-based sonothrombolytic (ST) device and a rotating dispersion wire (RDW). MATERIALS AND METHODS An arterial flow model was pressurized to 100 mm Hg and perfused with 1,000 mL/min normal saline. Tubing containing 7-mm x 30-cm bovine thrombus proximal to a 75% stenosis was inserted distal to a nonstenosed bypass. The effluent was passed successively through 1,000-, 500-, and 200-microm filters and a particle analyzer. The ST device and RDW were activated for 10 and 15 minutes, respectively, in randomized sequences of experimental sets with and without the use of 10-mg tissue-type plasminogen activator (tPA). Results are expressed as means and standard deviations of fraction of lysed clot in each category. RESULTS The ST device produced significantly fewer particulates larger than 1,000 microm (1.3% +/- 1.4) than did the RDW (16.8% +/- 8.4, P < .001) and significantly more particulates smaller than 10 microm (90.7% +/- 7.6) than did the RDW (73.9% +/- 9.5; P < .001) at comparable thrombolytic efficacy (P = .982) and without significant effect from tPA (P = .988). There were no significant differences between particles measuring 500-1,000 microm (ST device: 0.3% +/- 0.3, RDW: 0.4% +/- 0.3; P = .653) and those measuring 10-199 microm (ST device: 7.5% +/- 7.5, RDW: 8.6% +/- 3.8; P = .624). The amount of particles on the 200-microm filter after RDW activation (0.4% +/- 0.3) exceeded those trapped after use of the ST device (0.1% +/- 0.1, P = .007) but contributed relatively little overall. CONCLUSIONS In this in vitro model, the use of the ST device resulted in fewer large particulates than did the use of the RDW, with more clots being reduced to less than 10 microm.
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Affiliation(s)
- Gloria M Salazar
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA.
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Diehm N, Schillinger M, Minar E, Gretener S, Baumgartner I. TASC II Section E3 on the Treatment of Acute Limb Ischemia:Commentary From European Interventionists. J Endovasc Ther 2008; 15:126-8. [DOI: 10.1583/07-2255.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ferreira M, Monteiro M, Abuhadba G, Lanziotti L, Capotorto LF. Novas tecnologias, novas complicações: complicações após uso de novos dispositivos de selamento e de trombectomia arterial. J Vasc Bras 2007. [DOI: 10.1590/s1677-54492007000400015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Relatamos aqui um caso singular de complicação isquêmica, e também traumática, referente ao uso de dois novos dispositivos para utilização endovascular, ambos no mesmo paciente. Um é um dispositivo hemostático para selamento de punção (Angio-Seal®; - St. Jude Medical) e o outro, um cateter para trombectomia rotacional aspirativa percutânea (Rotarex®; - Straub Medical). Discutimos a indicação destes dispositivos em pacientes gravemente enfermos, com quadro de instabilidade hemodinâmica ou em estado de hipercoagulabilidade, associado à doença aterosclerótica femoral, por seu elevado potencial de complicações.
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Dosluoglu HH, Cherr GS, Harris LM, Dryjski ML. Rheolytic thrombectomy, angioplasty, and selective stenting for subacute isolated popliteal artery occlusions. J Vasc Surg 2007; 46:717-23. [PMID: 17764882 DOI: 10.1016/j.jvs.2007.05.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Accepted: 05/29/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We have observed that some patients with isolated popliteal artery occlusions (PAOs) harbor varying degrees of organized clot, as suggested by the rapidity with which these occlusions are traversed with the Glidewire. We hypothesized that debulking such PAOs by using rheolytic thrombectomy without adjunctive thrombolysis before percutaneous transluminal angioplasty and selective stenting (PTA/S) is safe and enables single-session treatment with minimal risk of embolization. METHODS Between February 2004 and January 2007, 16 male patients (mean age, 68.9 +/- 11.1 years; range, 54-84 years) presenting with disabling claudication (n = 1), rest pain (n = 5), and tissue loss (n = 10; mean duration, 11 +/- 8 weeks; range, 4-26 weeks) were prospectively followed up after rheolytic thrombectomy and angioplasty and selective stenting of their PAO. RESULTS The mean occlusion length was 11.6 +/- 4.5 cm. After rheolytic thrombectomy, the occlusions were converted to long stenoses (mean length of 7.6 +/- 3.6 cm). Self-expanding stents were used in 10 of 16 (mean length of 8.3 +/- 4.4 cm). Additional recanalizations of occlusions of the iliac artery and proximal superficial femoral artery were performed before popliteal artery recanalizations in two patients. Ankle-brachial indexes increased from 0.27 +/- 0.22 to 0.94 +/- 0.13. No case of distal embolization was observed. Adjuvant thrombolysis was used in only one case to improve runoff. Inline flow to the foot was achieved in 15 of 16 cases. Three occlusions occurred at 3, 6, and 20 months after surgery (mean follow-up, 15.7 +/- 10.0 months), and two patients underwent successful thrombolysis. The third patient refused further intervention and remains a claudicant. One-year primary and secondary patency rates were 84% and 92%, respectively. Two limb losses occurred at 7 and 9 months as a result of recurrent foot infection in patients with diabetes, both with patent popliteal arteries (1-year limb salvage rate, 83%). CONCLUSIONS We advocate debulking isolated subacute PAOs with rheolytic thrombectomy when they are easily crossed, because this enables recanalization of these lesions in a single setting, thus obviating the additional need for thrombolysis in most cases, with seemingly minimal risk of distal embolization. This simple approach is effective and widely available.
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Affiliation(s)
- Hasan H Dosluoglu
- Division of Vascular Surgery, Department of Surgery, State University of New York at Buffalo, Buffalo, NY 14215, USA.
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