4:26 PM Abstract No. 430 - Multicenter experience with angiojet rheolytic thrombectomy in thrombosed synthetic surgical bypass grafts

Abstract

Purpose Arterial bypass grafting is a common treatment for patients with claudication and critical limb ischemia. Graft thrombosis is a known complication of lower extremity bypass, associated with a high risk of acute limb ischemia (ALI). Catheter directed thrombolysis (CDT) without mechanical thrombectomy often involves prolonged procedures requiring intensive monitoring for several days. The study evaluated a multi center experience with rheolytic mechanical thrombectomy in the management of acute synthetic bypass graft occlusion. Materials and Methods Multi-center, retrospective review of endovascular database cataloguing 95 patients (mean age 66 years, range 42-89 years, 29 females/66 males) treated for ALI secondary to thrombosis in PTFE infrainguinal bypass grafts. All patients received rheolytic mechanical thrombectomy using the Angiojet system. Endpoints included angiographic success of procedure, duration of procedure, 30 day adverse events (death, MI, renal failure, bleeding), limb salvage, and survival at followup. Results Graft types treated included femoropopliteal (n=59), femorodistal (n=20), external iliac-popliteal (n=1), profunda-popliteal (n=1) and ilioprofunda (n=1). When reported, procedural success was achieved in 60/83 (72%) cases. Procedure failure was seen in 11/83 (13%) cases. CDT was administered in 68/95 (72%) of patients, with a mean procedure time of 20 hours. At 30 days, complications included bleeding requiring transfusion (8%, n=8) and acute renal failure (2%, n=2). All cases of acute renal failure resolved. Limb salvage at 30 days was attained in 79% (75/95) with mortality of 4% (4/95). At 30 days, 7% of patients required amputation (7/95), and 11% underwent graft surgical revision (10/95). Eleven patients have been lost to follow-up. At mean follow-up (10 months), amputation free survival was 80% (67/84), 20% of patients (17/84) had undergone amputation, and 12% underwent delayed revision (10/84). Mortality at follow-up was 13% (11/84). Conclusion Rheolytic therapy for acute thrombosis of synthetic bypass grafts is a safe and effective modality which can reduce treatment time in this critically ill and morbid patient population.