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Li W, Xing Y, Feng H, Chen X, Zhang Z. Percutaneous mechanical thrombectomy using the Rotarex ®S device for the treatment of acute lower limb artery embolism: A retrospective single-center, single-arm study. Front Surg 2023; 9:1017045. [PMID: 36684256 PMCID: PMC9859659 DOI: 10.3389/fsurg.2022.1017045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023] Open
Abstract
Objective Acute limb embolism (ALE) is a challenging, highly morbid, and frequently fatal vascular emergency. Percutaneous mechanical thrombectomy (PMT) devices are an alternative treatment to restore perfusion by removing emboli in the limb arterial system. We evaluated the outcomes of treatment of ALE patients using PMT devices in our center. Methods A retrospective review of ALE patients treated with Rotarex S (Straub Medical) at a single institution from 2018 to 2022 was performed. The primary outcome was technical success, defined as complete recanalization of the occluded segment with satisfactory outflow and good capillary filling of the distal parts of the foot without any major or obstructing residual emboli or thrombi either in the treated segment or in the outflow tract without the need for additional catheter-directed thrombolysis (CDT) or conversion to open surgery. Embolized segments treated, treatment outcomes, and perioperative complications were reviewed. Results A total of 17 ALE patients (29% men, 71% women; mean age, 73 years) underwent PMT procedures. The femoral arteries and popliteal arteries are the most commonly treated vessels, with both present in 59% of the patients. The technical success rate was 100%, but the majority of cases (82%) had concurrent percutaneous transluminal angioplasty or stent grafting, and two patients were treated with urokinase during the operation. There was one thrombotic recurrence that required amputation. There were no 30-day deaths. Complications included extravasation after PMT (two), intraoperative embolization of the outflow tract (one), access site hematoma (one), target artery thrombosis (one), and acute kidney injury (one). There were no severe bleeding complications. Conclusions The Rotarex S device has a satisfactory success rate, although complementary use of various adjunctive techniques is frequently required. It seems to be a moderately effective tool for treating ALE to avoid CDT or open surgery. The device appears safe, with low risks of amputation and mortality rates, but special attention should be given to the potential for extravasation and distal embolism.
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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: 5] [Impact Index Per Article: 1.7] [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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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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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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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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Migliara B, Cappellari TF, Mirandola M, Griso A, Kolasa K, Zah V, Nicoletti C, Lino M. Treatment of bypass failure in patients with chronic limb threatening ischemia – open surgery vs. percutaneous mechanical thrombectomy. VASA 2020; 49:395-402. [DOI: 10.1024/0301-1526/a000883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: Lower limb bypass occlusion in patients with chronic limb threating ischemia remains a challenge. We can choose between different treatment options: open surgery, local thrombolysis, thrombectomy/atherectomy devices. In this pilot study, we compare clinical outcomes and treatment costs between open surgery (OS) and percutaneous mechanical thrombectomy (pMTH). Patients and methods: This pilot study represents a retrospective analysis of hospital data of 48 occluded bypasses admitted from 2013 to 2018. Only patients presenting with severe ischemia and recrudescence of symptoms (Rutherford 4–6) were included in the current analysis. Two cohorts of patients were analysed: patients who underwent OS and patients that underwent pMTH. Primary clinical outcomes were one-year cumulative patency and limb salvage rates. Total cost was calculated as a sum of intra- and post-operative costs. To weigh clinical benefits against the economic consequences of OS versus pMTH a cost-effectiveness framework was adopted. Results: We analysed a series of 48 occluded bypasses 17 treated with open surgery and 31 with pMTH. Procedural success was 100% in both groups. When comparing one-year death rates ( p-value = .22) and re-occlusion rates ( p-value = .43), no statistically significant differences were observed between the two cohorts. Mean patency duration in the surgery cohort was significantly shorter ( p-value < .05). Primary patency (OS 41.2% vs. pMTH 48.4%) and limb salvage rate (OS 88.2% vs. pMTH 90.3%) at one year are similar in both groups. The total cost of surgery was substantially higher (OS 10,159€ vs. pMTH 8,401€) Conclusions: This pilot study, although limited to 48 occluded bypasses, demonstrates that endovascular treatment with pMTH is less invasive, less time consuming and less expensive, and produces greater health benefits than traditional OS.
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Affiliation(s)
- Bruno Migliara
- Vascular and Endovascular Unit, Department of Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | | | - Mattia Mirandola
- Vascular and Endovascular Unit, Department of Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Andrea Griso
- Vascular and Endovascular Unit, Department of Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Katarzyna Kolasa
- Economics and Healthcare Management Division, Kozminski University, Poland
| | | | - Cristian Nicoletti
- Diabetic Foot Unit, Department of Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Marcello Lino
- Vascular and Endovascular Unit, Department of Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
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Mechanical rotational thrombectomy with Rotarex system augmented with drug-eluting balloon angioplasty versus stenting for the treatment of acute thrombotic and critical limb ischaemia in the femoropopliteal segment. Wideochir Inne Tech Maloinwazyjne 2019; 14:311-319. [PMID: 31118999 PMCID: PMC6528111 DOI: 10.5114/wiitm.2018.80006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/23/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction Mechanical thrombectomy is an alternative to local thrombolysis for the treatment of severe ischaemia in the femoropopliteal segment, but stent implantation is usually required after this procedure. The use of drug-eluting balloons (DEBs) may overcome long-term problems associated with stents, but it remains unclear how often such a treatment is technically feasible and efficient. Aim This post hoc single-centre study was aimed at assessment of the feasibility, safety and efficacy of mechanical thrombectomy followed by application of DEBs. Material and methods Fifty-one patients, aged 69.1 ±11.6 years, were managed for acute thrombotic or chronic critical ischaemia in the femoropopliteal segment using the Rotarex device. Following mechanical thrombectomy, on condition that there was no significant residual stenosis or dissection, lesions were managed with paclitaxel-coated DEBs, which was a desired strategy (24 patients). The remaining 25 patients underwent stent implantations, which was regarded as bailout treatment. Final follow-up was scheduled 12 months after the procedure. Results The primary-assisted patency rate after mechanical rotational thrombectomy with additional balloon angioplasty and/or stenting was 97.1% (49 patients). The early mortality rate was 2.0% (1 patient) and the amputation rate was 4.1% (2 patients). There were no late mortalities or limb amputations at 12-month follow-up, but significant restenoses occurred in 13 (27.1%) patients. These restenoses were more frequent in patients who underwent stent implantation (45.5%) than those managed with DEBs (12.5%), and in patients managed for secondary lesions. Conclusions In selected patients mechanical rotational thrombectomy in the femoropopliteal segment followed by application of DEB is a safe, effective and long-lasting method of revascularisation.
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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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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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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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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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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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