Case Of Distal Embolization Research Articles

TCTAP C-258 A Complication Case of Distal Embolism During Endovascular Therapy for External Iliac Artery Occlusive Disease

TCTAP C-258 A Complication Case of Distal Embolism During Endovascular Therapy for External Iliac Artery Occlusive Disease

Feasibility of endovascular recanalization of occluded infrapopliteal drug-eluting stents.

To investigate the safety and feasibility of percutaneous endovascular recanalization of late total occlusions of infrapopliteal drug-eluting stents (DES). A retrospective study investigated all 408 infrapopliteal stent procedures performed in 367 patients between January 2007 and October 2013 to identify those who underwent percutaneous reintervention for symptomatic infrapopliteal balloon-expandable DES occlusion. The search identified 49 patients with at least one infrapopliteal DES occlusion in 61 (14.9%) of 408 limbs. Seven (14.3%) patients were excluded from the analysis owing to asymptomatic status (n=6) and acute thrombotic occlusion (n=1), leaving 42 patients who underwent endovascular revascularization of occluded stents in 54 limbs. The study's primary outcomes were technical success and complication rates of endovascular recanalization, while secondary outcomes included limb salvage and the identification of factors influencing primary results. Technical success was 90.7% (49/54 procedures). Technical failure was seen only in cases of stent collapse and overlapping native popliteal artery-infrapopliteal stent occlusion. According to Kaplan-Meier analysis, survival was 89.6%, 81.1%, and 73.5% at 1, 2, and 3 years, respectively, while limb salvage rates were 86.1%, 79.3%, and 72.7% at the same time points. There was 1 (1.8%) case of distal embolization. No factors influencing outcomes could be identified. Percutaneous recanalization of infrapopliteal stent total occlusions is safe and feasible. Technical failure was noted in cases of stent deformation occurring at the pedal artery and in overlapping native popliteal artery-infrapopliteal stent occlusion.

Abstract No. 227: Directional Atherectomy for In-Stent Restenosis of the Femoropopliteal Artery: Results of a Pilot Study

Initial results of a prospective non- randomized single center study to evaluate safety and effectiveness of directional atherectomy as a primary treatment modality for femoro-popliteal instent restenosis. 12 patients (70,8 ± 9,8 years) with restenosis following stent placement into the femoropopliteal artery were treated primarily with excisional atherectomy using the Silver Hawk™ device. Distal filter protection was not used. Primary objective is anatomical treatment success with residual stenosis < 30% or hemodynamically relevant dissection in the absence of complications. Secondary objective is target vessel patency at 6 and 12 months. Follow-up consists of clinical evaluation, ABI measurements and color coded duplex sonography. Angiography in performed in case of suspected restenosis. Most patients (11/12, 92%) were claudicants. Stents had been implanted for a mean period of 8,5 (± 8,2) months before the secondary procedure. Maximum grade of restenosis was 92,2% (±7,7), mean lesion length was 11,6 cm (±8,2). Length of stented vessel segments was 14,8 cm (±5,0) with one case of stent fracture. On intention-to-treat basis anatomical treatment success of excisional atherectomy alone was 67% (8/12). In half of the cases additional balloon angioplasty was performed for residual stenosis or proximal and distal de-novo lesions. Additional stents were implanted in 2/12 cases (16,7%). Overall treatment success of the revascularization procedure was 100%. Doppler index improved from 0,44 (±0,3) to 0,76 (±0,3). There was one case of distal embolization, managed by aspiration thrombectomy (1/12; 8,3%). One patient experienced reocclusion of the treated vessel before 30 days. Patency rates at 6 months are pending and will be presented. Directional atherectomy as a primary treatment modality for instent restenosis of the femoropopliteal artery is safe with promising initial success and low complication rates. If the theoretical advantage of removing neointimal tissue without repeated barotrauma also translates into a clinical benefit has to be proven by long-term follow-up.

Drug eluting stents for below the knee lesions in patients with critical limb ischemia

The purpose of this study was to assess the long-term limb preservation and/or healing of ulcers in patients with critical limb ischemia (CLI) and severe infrapopliteal atherosclerotic disease treated with drug eluting stents (DES). Percutaneous revascularization has become an effective treatment for CLI in patients with infrapopliteal atherosclerotic disease. Recent reports using DES in patients with CLI have documented excellent short-term infrapopliteal vessel patency. Higher primary patency rates in infrapopliteal vessels treated with DES could translate into better long-term clinical outcomes and improved limb salvage rates. Twenty-four consecutive patients with CLI (defined as rest pain, nonhealing ulcers, or gangrene) because of severe infrapopliteal disease were treated with DES from August 2004 to June 2006. Procedural success was achieved in 96% (27/28) of targeted lesions. There were no procedure-related deaths, acute vessel thrombosis events, or need for urgent surgical intervention. There was one case of distal embolization. Clinical follow up, ranging 8-34 months, is available for 100% of patients of which 83% (20/24) achieved limb preservation and healing. Angiographic and/or sonographic follow up, ranging 6-34 months, is available in 79% (19/24) of patients of which 95% (18/19) had patent target vessels. DES is a safe and effective long-term option for CLI due to severe infrapopliteal arterial disease. Long-term vascular patency led to a high rate of limb preservation and low amputation rate. A multicenter trial should further elucidate the role of DES in the treatment of CLI.

Rheolytic thrombectomy, angioplasty, and selective stenting for subacute isolated popliteal artery occlusions

We have observed that some patients with isolated popliteal artery occlusions (PAOs) harbor varying degrees of organized clot, as suggested by the rapidity with which these occlusions are traversed with the Glidewire. We hypothesized that debulking such PAOs by using rheolytic thrombectomy without adjunctive thrombolysis before percutaneous transluminal angioplasty and selective stenting (PTA/S) is safe and enables single-session treatment with minimal risk of embolization. Between February 2004 and January 2007, 16 male patients (mean age, 68.9 +/- 11.1 years; range, 54-84 years) presenting with disabling claudication (n = 1), rest pain (n = 5), and tissue loss (n = 10; mean duration, 11 +/- 8 weeks; range, 4-26 weeks) were prospectively followed up after rheolytic thrombectomy and angioplasty and selective stenting of their PAO. The mean occlusion length was 11.6 +/- 4.5 cm. After rheolytic thrombectomy, the occlusions were converted to long stenoses (mean length of 7.6 +/- 3.6 cm). Self-expanding stents were used in 10 of 16 (mean length of 8.3 +/- 4.4 cm). Additional recanalizations of occlusions of the iliac artery and proximal superficial femoral artery were performed before popliteal artery recanalizations in two patients. Ankle-brachial indexes increased from 0.27 +/- 0.22 to 0.94 +/- 0.13. No case of distal embolization was observed. Adjuvant thrombolysis was used in only one case to improve runoff. Inline flow to the foot was achieved in 15 of 16 cases. Three occlusions occurred at 3, 6, and 20 months after surgery (mean follow-up, 15.7 +/- 10.0 months), and two patients underwent successful thrombolysis. The third patient refused further intervention and remains a claudicant. One-year primary and secondary patency rates were 84% and 92%, respectively. Two limb losses occurred at 7 and 9 months as a result of recurrent foot infection in patients with diabetes, both with patent popliteal arteries (1-year limb salvage rate, 83%). We advocate debulking isolated subacute PAOs with rheolytic thrombectomy when they are easily crossed, because this enables recanalization of these lesions in a single setting, thus obviating the additional need for thrombolysis in most cases, with seemingly minimal risk of distal embolization. This simple approach is effective and widely available.

The Hydrolyser thrombectomy catheter: a single-center experience.

To present a single-center experience with a mechanical hydrodynamic thrombectomy system (Hydrolyser) in native arteries, veins, and bypass grafts. The Hydrolyser is a 7F, double lumen, over-the-wire thrombectomy catheter. The device was used in 41 patients (22 males; mean age 68 years, range 40 to 90), with recent thromboses (aged 1 to 30 days, mean 8.7+/-8.5), measuring from 4 to 35 cm long (mean 17.7+/-9.5). The occlusions were located in native lower limb arteries (n = 28), bypass grafts (n = 8), superior venae cavae (n = 2), axillary vein (n = 1), and pulmonary arteries (n = 2). Immediate technical success (residual clot < 50% of lumen diameter) was achieved in 34 patients (83%): 22/28 native arteries (78%), 7/8 bypass grafts (87%), and all pulmonary arteries, superior venae cavae, and the axillary vein. The 7 failed patients were treated surgically (bypass graft or Fogarty balloon). Adjunctive procedureswere used to maximize luminal diameter: angioplasty (n = 29, with 13 immediate stent implantations), thromboaspiration (n = 17), and thrombolysis (n = 10). One case of distal embolism was the only complication (treated by thromboaspiration). At 30 days, 30 (73%) vessels remained patent. The Hydrolyser system is a promising concept for percutaneous thrombectomy. It is a quick, reliable, efficient device that may offer an alternative to thrombolysis and surgical thrombectomy.

The Hydrolyser Thrombectomy Catheter:A Single-Center Experience

To present a single-center experience with a mechanical hydrodynamic thrombectomy system (Hydrolyser) in native arteries, veins, and bypass grafts. The Hydrolyser is a 7F, double lumen, over-the-wire thrombectomy catheter. The device was used in 41 patients (22 males; mean age 68 years, range 40 to 90), with recent thromboses (aged 1 to 30 days, mean 8.7+/-8.5), measuring from 4 to 35 cm long (mean 17.7+/-9.5). The occlusions were located in native lower limb arteries (n = 28), bypass grafts (n = 8), superior venae cavae (n = 2), axillary vein (n = 1), and pulmonary arteries (n = 2). Immediate technical success (residual clot < 50% of lumen diameter) was achieved in 34 patients (83%): 22/28 native arteries (78%), 7/8 bypass grafts (87%), and all pulmonary arteries, superior venae cavae, and the axillary vein. The 7 failed patients were treated surgically (bypass graft or Fogarty balloon). Adjunctive procedureswere used to maximize luminal diameter: angioplasty (n = 29, with 13 immediate stent implantations), thromboaspiration (n = 17), and thrombolysis (n = 10). One case of distal embolism was the only complication (treated by thromboaspiration). At 30 days, 30 (73%) vessels remained patent. The Hydrolyser system is a promising concept for percutaneous thrombectomy. It is a quick, reliable, efficient device that may offer an alternative to thrombolysis and surgical thrombectomy.

The use of the Wallstent in aorto-iliac vascular disease

Forty-three patients had self-expanding endovascular Wallstents inserted for aorto-iliac arterial disease. A total of 59 Wallstents were inserted into 50 iliac arteries. There were 27 males and 16 females with a mean age of 62.51 years. Included in the series were 19 iliac occlusions, 21 severe atheromatous disease of the aortoiliac segment, two severe dissections following conventional angioplasty and one re-stenosis of a previously dilated iliac segment. All of the stents were successfully deployed but there were five significant complications. One case of distal embolism was treated by surgical embolectomy but the other four were treated by an additional percutaneous technique. At follow-up after 6 months all patients remain symptomatically improved. Aorto-iliac stenting is a cost-effective treatment in selected cases of severe aorto-iliac disease.