Embosafe – A Novel Percutaneous Technique for Aorto-Iliac Thrombectomy without the Risk of Embolization

Abstract

Abstract Background Aortoiliac thrombectomies have become more common during the Covid-19 pandemic. Classic surgical thrombectomy of the aorta and iliac arteries through an incision in the groin vessels harbours the risk of embolization to the viscero-renal as well as hypogastric arteries while percutaneous endovascular thrombectomy techniques can lead to peripheral embolization to the lower limb. Aims To describe a novel, percutaneous technique that tackles the above issues and to present our initial experience using it. Methods The principle of the technique is to percutaneously place large bore sheaths in the iliac arteries that deliberately occlude the latter to protect the lower limbs from embolization. Through one of these sheats, over the wire Fogarty® catheters can be placed and inflated in the ostia of the coeliac trunk, superior mesenteric artery, renal arteries and hypogastric arteries as needed. A large thrombectomy balloon catheter is then used to bring any aorto-iliac thrombus into the sheaths whereafter thrombus is removed from the sheaths by simply deflating their valves. Additional endovascular procedures of the aorto-iliac branches can be performed as needed. Results We report eight EmboSafe procedures in 7 patients (3 male, 4 female) with a median age of 61 (53-60). Sheaths were sized between 18F and 24F. Additional endovascular procedures had to be performed in 5 (62.5%) procedures, including relining of a renal briding stentgraft, thrombectomy of the coeliac trunk, kissing stentgrafts in the aortic bifurcation, thrombectomy of a hypogastric artery, one CERAB and stenting of a renal artery. All procedures were technically successful and all patients had palpable foot pulses on completion of the procedures. No patient had clinical signs of peripheral embolization. Conclusions EmboSafe is a very valid addition to the vascular surgeon's armamentarium when treating aorto-iliac thrombotic events because it is minimally invasive while still protecting against embolization and while offering the flexibility to perform additional endovascular procedures.