Percutaneous infusion system for in situ thrombolysis in the abdominal aorta and iliac arteries

Use of Trellis thrombectomy system in acute aortofemoral graft occlusion

Acute aortofemoral graft occlusion is often effectively treated with endovascular therapy but a substantial proportion of patients experience failure or complications of this therapy, and most of them require definitive surgery for the underlying inflow, outflow, or graft disease. We describe a case of an aortofemoral graft occlusion that was successfully treated with the Trellis thrombectomy-thrombolysis system (Covidien, Dublin, Ireland). Subsequent stenting of the graft obviated the need for a definitive graft revision surgery. The Trellis system combines mechanical and local pharmacologic lysis of the thrombus, with more rapid and more effective thrombus dissolution and theoretically less risk of systemic dispersion of the thrombolytic agent and less bleeding.

Salvage of critical limb ischemia with the "trellis reserve'' of subintimal superficial femoral-popliteal artery occlusion: a new modality in managing critical limb ischemia--a case report

Subintimal angioplasty is a safe, effective, but nondurable procedure in treating long superficial femoral artery occlusions in patients with severe lower limb ischemia. The authors report a case of acute thrombosis that presented 16 weeks after subintimal angioplasty. The ;;Trellis'' percutaneous thrombolytic infusion system permitted a controlled site-specific infusion of recombinant tissue-type plasminogen activator (rtPA). The unique design of the ;;Trellis'' allowed complete aspiration of thrombus and avoiding regional and systemic thrombolytic side effects. The ;;Trellis'' system is effective in percutaneous management of thrombotic lesions; however, intimal dissection may need to be addressed.

Controlled localized thrombolysis with the "turbo" trellis to treat acute arterial occlusions following major surgery

PURPOSE

To present the management of acute arterial ischemia following major abdominal and orthopedic surgery using a percutaneous thrombectomy device and a low dose of thrombolytic agent.

CASE REPORT

A 38-year-old woman with T-8 paraplegia from a traumatic fall developed pelvic osteomyelitis, for which a left hemipelvectomy, hysterectomy, and partial vaginal resection were performed. Twelve hours after the procedure, the patient developed an ischemic left leg. Computed tomographic angiography demonstrated an occlusion of the left external iliac and common femoral arteries. A Turbo Trellis percutaneous thrombectomy device was used to lyse the left external iliac artery thrombosis using 1 mg of tissue plasminogen activator infused between the proximal and distal occluding balloons of the device. Total dispersion time was 5 minutes. There was complete thrombus removal without any significant bleeding complications. At 6 months, the artery remains widely patent.

CONCLUSIONS

Combination therapy with mechanical thrombectomy devices and low dose thrombolytic agents can be used to treat acute arterial occlusions at a single setting. The increased speed of the Turbo Trellis may allow for smaller doses of thrombolytic agents and shorter treatment times.

Trellis thrombectomy system for the treatment of iliofemoral deep venous thrombosis

PURPOSE

To describe the use of a new percutaneous mechanical thrombectomy device to clear thrombus from the iliofemoral vein.

CASE REPORT

A 52-year-old woman with non-Hodgkin's lymphoma presented to the emergency room with a posterior tibial vein deep vein thrombosis and a greater saphenous vein thrombosis. Heparin therapy caused the clot to propagate into the iliofemoral vein. Catheter-directed thrombolysis for 36 hours with 24 units of reteplase failed to clear the clot. The Trellis Thrombectomy System, a new percutaneous mechanical thrombectomy device, was used to deliver a low dose of reteplase into the clot. Complete clot lysis was achieved in 45 minutes using only 5 units of reteplase. The patient's symptoms resolved completely, and she continues to be asymptomatic at 6 months with no evidence of residual clot on duplex scans.

CONCLUSIONS

The Trellis device may be used to rapidly clear thrombus from the iliofemoral vein with a low dose of thrombolytic agent.

The Trellis Thrombectomy System in the treatment of acute limb ischemia

PURPOSE

To report the use of a new percutaneous mechanical thrombectomy device in the treatment of acute limb-threatening ischemia.

TECHNIQUE

The Trellis Thrombectomy System is a 7-F drug dispersion catheter that features a treatment segment isolated by proximal and distal occlusion balloons, which help prevent distal embolization and systemic release of the infused thrombolytic agent. After inflating the distal balloon, the thrombolytic agent is infused and held at the target site by inflation of the proximal balloon. An oscillating dispersion wire optimizes dispersal of the thrombolytic agent as the thrombus is mechanically fragmented. The liquefied thrombus is then aspirated. Four consecutive patients with acute lower extremity ischemia secondary to bypass graft thrombosis were treated with the Trellis thrombectomy catheter. Overall, 95% of thrombus was successfully removed from the treatment zone, with no device-related complications. Only one patient required adjunctive thrombolytic therapy after thrombectomy with the Trellis device.

CONCLUSIONS

The Trellis thrombectomy device is a safe and effective technique to isolate the infused thrombolytic agent in association with mechanical fragmentation for rapid blood flow restoration.