Advertisement

CardioVascular and Interventional Radiology

, Volume 42, Issue 2, pp 178–185 | Cite as

Percutaneous Mechanical Thromboembolectomy in Acute Lower Limb Ischemia

  • Dierk VorwerkEmail author
  • Stefan Triebe
  • Steffen Ziegler
  • Volker Ruppert
Clinical Investigation Arterial Interventions
Part of the following topical collections:
  1. Arterial Interventions

Abstract

Purpose

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

Material and Method

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

Results

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

Conclusion

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

Keywords

Arterial occlusion Acute ischemia Mechanical thrombectomy Aspiration embolectomy Rotational thrombectomy 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Starck E, McDermott J, Crummy A, Turnipseed W, Acher C, Burgess J. Percutaneous aspiration thromboembolectomy. Radiology. 1985;156:51–6.CrossRefGoogle Scholar
  2. 2.
    Sniderman K, Bodner L, Saddekni S, Srur M, Sos T. Percutaneous embolectomy by transcatheter aspiration. Work in progress. Radiology. 1984;150:357–61.CrossRefGoogle Scholar
  3. 3.
    Rutherford R, Flanigan P, Gupta S, Johnson W, Karmody A, Whittemore A, Baker D, Ernst C, Jamieson C, Mehta S. Suggested standards for reports dealing with lower extremity ischemia. J Vasc Surg. 1986;4:80–94.CrossRefGoogle Scholar
  4. 4.
    Dregelid E, Stangeland L, Eide G, Trippestad A. Patient survival and limb prognosis after arterial embolectomy. Eur J Vasc Surg. 1987;18:263–71.CrossRefGoogle Scholar
  5. 5.
    Morrison H. Catheter-directed thrombolysis for acute limb ischemia. Semin Interv Radiol. 2006;23:258–69.CrossRefGoogle Scholar
  6. 6.
    Filippiadis D, Binkert C, Pellerin O, Hoffmann R, Krajina A, Pereira P. Cirse quality assurance document and standards for classification of complications: the Cirse classification system. Cardiovasc Interv Radiol. 2017;40:1141–6.CrossRefGoogle Scholar
  7. 7.
    Rajan D, Patel N, Valji K, Cardella J, et al. Quality improvement guidelnes for percutaneous management of acute limb ischemia. J Vasc Intervent Radiol. 2009;20:S208–18.CrossRefGoogle Scholar
  8. 8.
    Kashiap V, Gilani R, Bena J, Bannazadeh M, Sarac T. Endovascular therapy for acute limb ischemia. J Vasc Surg. 2011;53:340–6.CrossRefGoogle Scholar
  9. 9.
    Wagner H, Starck E. Acute embolic occlusions of the infrainguinal arteries: percutaneous aspiration embolectomy in 102 patients. Radiology. 1992;182:403–7.CrossRefGoogle Scholar
  10. 10.
    Zeller T, Frank U, Bürgelin K, Müller C, Flügel P, Horn B, Schwarzwälder U, Neumann F. Early experience with a rotational thrombectomy device for treatment of acute and subacute infra-aortic arterial occlusions. J Endovasc Ther. 2003;10:322–31.Google Scholar
  11. 11.
    Duc S, Schoch E, Pfyffer M, Jenelten R, Zollikofer C. Recanalization of acute and subacute femoropopliteal artery occlusions with the rotarex catheter: one year follow-up, single center experience. Cardiovasc Interv Radiol. 2005;28:603–10.CrossRefGoogle Scholar
  12. 12.
    Heller S, Lubanda J, Varejka P, Chochola M, Prochazka P, Rucka D, Kuchynkova S, Horakova J, Linhart A. Percutaneous mechanical thrombectomy using Rotarex S device in acute limb ischemia in infrainguinal occlusions. BioMed Res Int. 2017;1:1.  https://doi.org/10.1155/2017/2362769.CrossRefGoogle Scholar
  13. 13.
    Kwok CHR, Fleming S, Chan K, Tibballs J, Samuelson S, Ferguson J, Nadkarni S, Hockley J, Jansen S. Aspiration thrombectomy versus conventional catheter-directed thrombolysis as first-line treatment for noniatrogenic acute lower limb ischemia. J Vasc Interv Radiol. 2018;29:607–13.CrossRefGoogle Scholar
  14. 14.
    Vorwerk D, Guenther RW, Schürmann K. Stent placement on fresh venous thrombosis. Cardiovasc Interv Radiol. 1997;20:359–63.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of RadiologyKlinikum IngolstadtIngolstadtGermany
  2. 2.Department of Vascular SurgeryKlinikum IngolstadtIngolstadtGermany

Personalised recommendations