Endovascular treatment of acute limb ischemia with pharmachomechanical thrombectomy: Single center experience

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1 Endovascular treatment of acute limb ischemia with pharmachomechanical thrombectomy: Single center experience Poster No.: C-2054 Congress: ECR 2010 Type: Scientific Exhibit Topic: Interventional Radiology Authors: A. Klepanec, I. P. Vulev, T. Balázs, M. Majer#ík, J. Mikuláš, D. Hladíková, T. Kozlovská, J. Ma#ari#; Bratislava/SK Keywords: Pharmacomechanical thrombectomy, Acute limb ischemia, Thrombolysis DOI: /ecr2010/C-2054 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 19

2 Purpose To evaluate the safety and efficacy of pharmacomechanical thrombectomy (PMT) using Angiojet rheolytic thrombectomy system with rt-pa flush in the treatment of acute limb ischemia. Methods and Materials Between April 2007 and March patients (mean age 67,4 years; 46% Rutheford I; 43% Rutheford IIa; 11% Rutheford IIb) with acute limb ischemia were treated with pharmacomechanical thrombectomy in our department. Primary patency rate and limb salvage were evaluated at 6 month follow up. During the interventional procedure after passing the acute occlusio# with the guidewire, pharmacomechanical thrombectomy of the occlusion with Angiojet catheter flush with 20mg rt-pa mixed with 250mg saline was performed. If necessary, adjunctive local thrombolysis was administered for residual clot removal. Page 2 of 19

3 Images for this section: Page 3 of 19

4 Fig. 1: Case year old patient with acute critical limb ischemia. Digital subtraction angiography (DSA) with acute proximal superficial artery (SFA) occlusion before pharmacomechanical thrombectomy (PMT). Page 4 of 19

5 Fig. 2: Case 1. DSA before PMT with patent distal SFA and popliteal artery (PA). Page 5 of 19

6 Fig. 3: Case 1. DSA after pharmacomechanical thrombectomy revealing critical proximal SFA stenosis. Page 6 of 19

7 Fig. 4: Case 1. DSA after stent ((6x40mm) implantation in the proximal SFA. Page 7 of 19

8 Page 8 of 19

9 Fig. 5: Case 1. DSA of patent PA and diffusely diseased infrapopliteal vessels after proccedure. Page 9 of 19

10 Results The mean duration of limb ischemia was 5 days (5 hours to 8 days). The mean length of thrombotic occlusion was 17 (3-25) cm. Technical success rate was 100%. Single session rapid blood flow restoration was achieved in 111 patients (80,5%). In 27 patients (19,5%) adjunctive local thrombolysis was necessary for residual clot removal with mean thrombolysis duration of 14 hours (4-24 hours). No major complications or macroscopic peripheral embolisation occured during and after the procedure. Underlying culprit lesions were treated with PTA (n=39) and stent implantation (n=99). The mean procedure time of PMT was 48±20 minutes. The limb salvage at 6 month follow-up was 89,8%. The primary patency rate at 6 month follow-up was 85,2%. Images for this section: Page 10 of 19

11 Fig. 1: Case year old patient with acute limb ischemia, DSA with acute femoropopliteal (FP) bypass occlusion with 2 vessels run-off (anterior tibial and peroneal artery). Page 11 of 19

12 Fig. 2: Case 2. DSA after pharmacomechanical thrombectomy revealing critical stenosis of proximal and distal FP bypass anastomosis. Page 12 of 19

13 Fig. 3: Case 2. DSA after PTA of proximal and distal FP bypass anastomosis with patent bypass, popliteal artery a 2 vessels run-off. Page 13 of 19

14 Fig. 4: Case year old patient with acute in stent occlusion of SFA with patent popliteal artery and 2 vessels run-off. Page 14 of 19

15 Fig. 5: Case 3. DSA after pharmacomechanical thrombectomy revealing critical in stent restenosis due to neointimal hyperplasia. Page 15 of 19

16 Fig. 6: Case 3. DSA after PTA of critical in stent lesions with patent SFA, popliteal artery and 2 vessels run-off with no peripheral embolisation. Page 16 of 19

17 Conclusion Endovascular treatment of acute limb ischemia with pharmacomechanical thrombectomy with rtpa flush is safe and effective therapeutic method with rapid blood flow restoration, high limb salvage and primary patency. Further evaluation is necessary. Images for this section: Fig. 1 Page 17 of 19

18 References 1. Kasirajan K, Haskal ZJ, Ouriel K. The use of mechanical thrombectomy devices in the management of acute peripheral arterial occlusive disease. J Vasc Interv Radiol 2001;12: Ansel GM, George BS, Botti CF, et al. Rheolytic thrombectomy in the management of limb ischemia: 30-day results from a multicenter registry. J Endovasc Ther. 2002;9(4): F. Castañeda, R. Li, J. Patel, J. R. DeBord, and J. L. Swischuk. Comparison of Three Mechanical Thrombus Removal Devices in Thrombosed Canine Iliac Arteries Radiology, April 1, 2001; 219(1): Andaz S, Shields DA, Scurr JH, Smith PD. Thrombolysis in acute lower limb ischaemia. Eur J Vasc Surg Nov;7(6): Lin PH, Mussa FF, Hedayati N, Naoum JJ, Wei Z, Qizhi Y, Kougias P, El Sayed HF, Changyi C. Comparison of AngioJet Rheolytic Pharmacomechanical Thrombectomy versus AngioJet Rheolytic Thrombectomy in a Porcine Peripheral Arterial Model. World journal of surgery 2007; 31(4): Suarez JA, Meyerrose GE, Phisitkul S, et al. Review of catheter thrombectomy devices. Cardiology. 2004;102(1): Mertens H, Van Holsbeeck B, Gryspeerdt S, Gellens P, Baekelandt M, Lefere P. Percutaneous treatment of acute multiple limb ischemia. JBRBTR Oct;83(5): Kasirajan K, Gray B, Beavers FP, Clair DG, Greenberg R, Mascha E, Ouriel K. Rheolytic Thrombectomy in the Management of Acute and Subacute Limb-threatening Ischemia. Journal of Vascular and Interventional Radiology. 2001; 12(4): Allie DA, Hebert CJ, Lirtzman MD et al., Novel simultaneous combination chemical thrombolysis/rheolytic thrombectomy therapy for acute critical limb ischemia: The power-pulse spray technique. Catheterization and Cardiovascular Interventions. 2004; 63(4): Müller-Hülsbeck S, Kalinowski M, Heller M, Wagner HJ. Rheolytic Hydrodynamic Thrombectomy for Percutaneous Treatment of Acutely Occluded Infra-aortic Native Arteries and Bypass Grafts: Midterm Follow-Up Results. Investigative Radiology. 2000; 35(2): 131. Personal Information Page 18 of 19

19 Contact adress: Andrej Klepanec, MD Department of Diagnostic and Interventional Radiology National Institute of Cardiovascular Diseases Pod Krásnou Hôrkou Bratislava 37, Slovakia Tel andrej.klepanec@nusch.sk Page 19 of 19

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