Twelve months outcome after percutaneous mechanical thrombectomy for treatment of acute femoropopliteal bypass occlusion
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ORIGINAL ARTICLE
Twelve months outcome after percutaneous mechanical thrombectomy for treatment of acute femoropopliteal bypass occlusion Michael Lichtenberg • Wilhelm Stahlhoff Dirk Boese • Birgit Hailer
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Received: 2 October 2012 / Accepted: 29 November 2012 / Published online: 15 December 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2012
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 RotarexÒ 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 RotarexÒ 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. Keywords Acute limb ischemia Femoropopliteal bypass Rotational thrombectomy Restenosis
M. Lichtenberg B. Hailer Cardiovascular Clinic, Vascular Center, Katholisches Klinikum Essen, Essen, Germany M. Lichtenberg (&) W. Stahlhoff D. Boese Vascular Center, Klinikum Arnsberg GmbH, Stolte Ley 5, 59759 Arnsberg, Germany e-mail: [email protected]
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Introduction Acute ischemia of the limbs is characterized by a significant reduction in arterial perfusion, which can mean life-threatening complications for affected patients. The existing hypoperfusion related anaerobic local as well as systemic metabolic situation can have direct negative effects on other organ systems such as the kidneys, brain and heart. The therapeutic management to be immediately established therefore includes the decision regarding appropriate reperfusion measures in addition to general, mostly intensive care measures. In the case of acute femoropopliteal bypass occlusions, local lysis has been established as an alternative measure in addition to the established vascular intervention (Fogarty maneuvers, endarterectomy, another bypass operation). Therapeutic recommendations based on large randomized studies on local lysis can be found on this in the current TASC Working Group Guidelines [1–4]. Percutaneous mechanical thrombectomy (PMT) has also been proven as an additional therapy option in recent years. Because o
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