Mechanische Rotationsthrombektomie zur Behandlung von akuten und subakuten Okklusionen der femoropoplitealen Arterien: Retrospektive Auswertung der Ergebnisse von 1999 bis 2005

Abstract

Direct intra-arterial thrombolysis is the standard of care over acute surgical intervention for acute infrainguinal occlusion. However, several mechanical thrombectomy devices can be utilized as a less invasive alternative to rapid reperfusion of the acutely threatened limb. Retrospective analysis of 265 patients treated from 1999 to 2005, mean age 65+/-8.4 (range from 47 to 75) years, with acute (85 patients, 32.1 %, group 1) or subacute (180 patients, 67.9 %, group 2) occlusions of the femoropopliteal artery with a rotational thromboembolectomy system (Straub Rotarex). The mean occlusion length was 25 (range 2 - 40) cm. The technical success rate was 94.7 % (251 / 265). In the additional 14 patients, no complete clot removal (n = 9) or intraluminal guidewire passage was able to be achieved (n = 5). After a mean follow-up of 12 +/-3 months, the restenosis rate was 49 % in group 1 and 54 % in group 2. The ankle-brachial index improved in group 1 from 0.32 +/- 0.17 to 0.78+/- 0.24 at discharge and 0.71 +/- 0.23 after 12 months (p < or =0.001) and in group 2 from preinterventional 0.47+/- 0.24 to 0.81 +/- 0.19 at discharge and 0.74 +/- 0.24 after 12 months (p < or = 0.001). There were 16 (6 %) distal embolizations and 3 (1.2 %) perforations. There were no cases of amputation or death during follow-up. The mechanical rotational thrombectomy is a very safe and effective alternative to local lysis. The only limitation is that there is no treatment possible in the infrapopliteal artery.