Percutaneous Aspiration Thrombectomy Research Articles

Asymptomatic bradycardia as a manifestation of intermediate high-risk pulmonary embolism

Progressively worsening dyspnea as an initial manifestation of an intermediate high-risk pulmonary embolism (PE) is a readily reported life-threatening cardiac emergency. Atypical presentation of PE may make the initial diagnosis challenging and is often the reason it is missed by clinicians. A 60-year-old woman with asymptomatic bradycardia presented with shortness of breath and dizziness. On examination, she was noted to have a heart rate of 40 beats per minute (bpm) which slightly improved to 55 bpm after intravenous (IV) fluids were administered. A transthoracic echocardiogram (TTE) showed evidence of severe right ventricular strain. Chest computed tomography angiogram (CTA) confirmed PE. After percutaneous aspiration thrombectomy, she was transitioned to direct oral anticoagulant (DOAC) from a heparin infusion and discharged on oral anticoagulation. Notably, her hospital course was marked by labile cycles between normotension and hypertension, with blood pressures exceeding 200/100 mmHg. The possibility that hypertensive states may prevent hemodynamic deterioration and a resulting high-risk pulmonary embolism is considered in patients presenting with multiple risk factors for thromboembolism.

Single-center Experience with JETi Hydrodynamic Thrombectomy System for Arterial Occlusions of the Extremities

Percutaneous aspiration thrombectomy is a new modality for treating patients with acute limb ischemia (ALI). We report our experience and outcomes using the JETi hydrodynamic thrombectomy system (Abbott Vascular, Abbott Park, IL) to treat acute arterial occlusions of the extremities. This a single-center retrospective review of patients with acute occlusions of peripheral arteries or grafts treated with the JETi from September 2020 to December 2022. JETi was used either as primary intervention or as an adjunct to treat distal vessel thrombus after proximal open thrombectomy. The primary outcome for success was defined as >50% luminal opening post-intervention. Indications, limb salvage, and major adverse events were reviewed. The JETi was used in 59 procedures (56 acute lower extremity ischemia [ALEI], three acute upper extremity ischemia [AUEI]) to treat 124 arteries in 57 patients. Mean age was 62 years (range, 29-95 years), and 49% were male. The mean duration of symptoms before hospitalization was 4.8 days (range, 0 hours to 21 days) for ALEI. The primary outcome was achieved in 102 of 124 (83%) arteries by JETi alone. Additional modalities including open thrombectomy, angioplasty, and stenting were used in five arteries to achieve the primary outcome. Seventeen arteries failed to achieve primary outcome with JETi with or without an adjunct. Reasons for failure were attributed to small artery size and chronic nature of the clot. Complete luminal patency with JETi thrombectomy alone was achieved in 52 arteries (42%). Additionally, 55 arteries underwent additional procedures (angioplasty and stenting) to restore complete luminal patency, which was successfully achieved in 49 vessels (89%) (Table). Average estimated blood loss in JETi-only procedures was 335 mL and 384 mL in those who underwent adjunctive procedures to achieve the primary outcome. Complications included distal embolization (5), access site hematoma (3), and acute kidney injury (AKI) (8). Two AKIs were attributed to rhabdomyolysis with creatine phosphokinas >10,000 IU/L; none of whom needed dialysis. There was a single 30-day mortality. Six patients required major limb amputations within 30 days – two after unsuccessful recanalization and one each for severe gangrene despite restoration of in-line flow, reocclusion of a distal bypass graft, recurrent ALEI postoperative day 15 with non-viable muscle on exploration, and a delayed compartment syndrome diagnosis. Success of the JETi to remove the targeted clot was 83%. The JETi system is an efficacious and safe tool for use in the treatment of acute artery occlusion.TableJETi thromboembolectomy technical success outcomes by vessel/graft intervened uponName of artery/graftNo. of each vesselJETi >50%JETi + adjunctive >50%JETi 100%JETI + adjunctive 100%JETI 4- adjunctive 50% <X <100%Aorta000000Common iliac660150External iliac642150Common femoral440310Superficial femoralI8170313IProfunda iroris220100Popliteal20I80882Anterior tibial16111840Tibioperoneal trunk13110821Peroneal artery13100910Posterior tibial1382631Femoral-anterior tibial bypass330030Femoral-popliteal bypass55004lAxillary femoral bvpass110100Axillary200000Subclavian110100Brachial110100124101552496 Open table in a new tab

Penumbra Indigo Percutaneous Aspiration Thrombectomy System in the treatment of Aortic Endograft Iliac Limb Occlusion: Results from an Italian Multicentre Registry

This study aimed to evaluate the safety and effectiveness of the Penumbra Indigo percutaneous aspiration thrombectomy (PAT) system in the clinical presentation of iliac limb occlusion (ILO) after endovascular aortic repair (EVAR). A retrospective, observational, multicentre study conducted in eight Italian vascular centres. Consecutive patients presenting with ILO after EVAR were eligible. To assess vessel revascularisation, Thrombo-aspiration In Peripheral Ischaemia (TIPI) classification (score 0-3) was used at presentation (t1), after PAT (t2), and after adjunctive procedures (t3). Successful revascularisation was considered TIPI 2-3 (near complete or complete). Primary intra-operative outcomes were technical success (TS) of Indigo PAT and combined TS of PAT associated with adjunctive procedures when needed. Primary follow up outcomes were safety and effectiveness at one, six, and 12 months. From September 2019 to December 2021, there were 48 ILO and 17 patients (35%) [median age 75 years, IQR 71, 83 years; male, 14 (82%); urgent, 8 (47%)] were treated and enrolled. The median time after primary EVAR was 24 months (IQR 0, 42 months). The median clot age from ILO diagnosis to PAT was three days (IQR 1, 12 days). Ten patients (59%) presented with limb threatening ischaemia. At t1, TIPI 0 and 1 was present in 13 (76%) and four (24%) cases, respectively. At t2, primary TS (TIPI 2-3) was achieved in 14 cases (82%) after Indigo PAT (p < .001). Fifteen patients (88%) required adjunctive procedures (14 re-linings, one surgical patch angioplasty). At t3, combined TS was achieved in 16 cases (94%). Intra-operative complication included one (6%) distal embolisation, treated successfully. The 30 day mortality was one case (6%) due to pneumonia. At one, six, and 12 months, clinical success was 100% without ILO recurrence. The median follow up was 23 months (IQR 11, 41 months): at 18 months, survival and freedom from re-intervention were 91 ± 8% and 90 ± 9%, respectively. This study reports for the first time the efficacy and safety of Penumbra Indigo PAT for ILO after EVAR, with promising technical and clinical success up to one year.

Abstract 15294: Right Atrial Thrombus Extraction Through Angiovac - A Challenge Based on Chronicity

Case Presentation: 23-year-old woman with right ovarian dysgerminoma, treated with debulking surgery and bleomycin, etoposide, and platinum, found to have a right atrial (RA) mass on post-chemotherapy surveillance CT and referred to the cardiology clinic. Her vitals were stable, lungs were clear to auscultation, RRR without murmurs, no JVD or LE edema. On labs, hgb:11g/dL and LDH:283 units/L(135 to 214 units/L). A transthoracic echocardiogram (TTE) and a cardiac MRI revealed a mass of RA at the junction of inferior vena cava (IVC) entry into RA, measuring 3x1.3 cm in the 2-chamber view and 2.4x1.8 cm in the 4-chamber view (Fig A,B) with prolapse into the right ventricle (RV) in diastole. Based on cardiac MRI’s short and long inversion time imaging characteristics, thrombus was the most likely diagnosis (Fig C). Shared decision-making with the patient included options: 1) open heart surgery for removal; 2) interventional aspiration thrombectomy; or 3) conservative treatment with anticoagulation (AC). After six weeks of AC with enoxaparin, TTE revealed a RA thrombus of the same size as previously (2.8x1.2 cm). Given the lack of improvement, she agreed to an invasive procedure to remove the mass using an AngioVac aspiration system (AngioDynamics, Latham, NY). The AngioVac cannula maneuvered in the RA under fluoroscopic and TEE guidance to capture the RA mass. However, the mass broke into two pieces, one piece still attached to the RA and the other piece lodged in the AngioVac cannula (Fig D,E). She remained hemodynamically stable after the procedure. The pathology of the RA mass revealed an organized thrombus (Fig F). She had no complaints on follow-up in the clinic and continued on AC for 6 months. Discussion: Percutaneous aspiration thrombectomy using the AngioVac system has become a novel option for removing commonly encountered intravascular material, such as fresh thrombi or emboli in the RA, RV, SVA, IVC, and the iliofemoral vein, but may be complicated in old thrombi.

Percutaneous aspiration thrombectomy as an optional treatment for pulmonary embolism

Percutaneous aspiration thrombectomy as an optional treatment for pulmonary embolism

Single-Center Experience With JETi Aspiration Thrombectomy for Acute and Subacute Lower Limb Ischemia

Acute lower extremity ischemia (ALEI) is a vascular surgery emergency with significant morbidity and mortality. Percutaneous aspiration thrombectomy is an alternative approach to removing thrombus from peripheral arteries. We evaluated the outcomes of ALEI treated with percutaneous aspiration thrombectomy using the JETi device.

Percutaneous Aspiration Thrombectomy of Thrombus Attached to Left Atrial Surface of a Watchman FLX Device.

Percutaneous Aspiration Thrombectomy of Thrombus Attached to Left Atrial Surface of a Watchman FLX Device.

Percutaneous Aspiration Thrombectomy for Arterial Thromboembolic Occlusion Following Percutaneous Transluminal Angioplasty: Technical Success Rates and Clinical Outcomes.

We aimed to analyze the technical success rate of manual percutaneous aspiration thrombectomy (PAT) in patients with peripheral arterial thromboembolism as a complication of infrainguinal percutaneous transluminal angioplasty (PTA) and we sought to evaluate the 30-day postintervention clinical outcome. We retrospectively identified 29patients (men/women, 18/11; mean age, 74 years) who underwent infrainguinal PAT to treat thromboembolic complications of infrainguinal PTA. Primary and secondary technical successes were defined as residual stenosis of < 50 % of the vessel diameter after PAT alone and PAT with additional PTA, respectively. Clinical outcome parameters (e. g., amputation, need for further intervention) were evaluated during the first 30 days after intervention. The primary and secondary technical success rates were 58.6 % (17/29) and 79.3 % (23/29), respectively. Clinical outcome data were available for 93.1 % (27/29) of patients. No further intervention was required within 30 days in 81.5 % (22/27) of patients. Four patients underwent minor amputations owing to preexisting ulcerations (Rutherford Category 5), and no patients underwent major amputations (Rutherford Category 6). Revascularization of the previously treated vessel segment with PTA was necessary on the first postintervention day in one patient. Manual PAT, with PTA if needed, has a good technical success rate and satisfactory early clinical outcome in patients with iatrogenic thromboembolic complications after infrainguinal PTA. · Manual PAT is a possible first-choice treatment of infrainguinal PTA-induced acute thromboembolism.. · Performing additional PTA increases the success rate of manual PAT.. · Unlike catheter-directed intraarterial lysis, manual PAT carries no risk of bleeding.. · Schicho A, Bäumler W, Verloh N et al. Percutaneous Aspiration Thrombectomy for Arterial Thromboembolic Occlusion Following Percutaneous Transluminal Angioplasty: Technical Success Rates and Clinical Outcomes. Fortschr Röntgenstr 2022; 194: 291 - 295.

Evaluation of inferior vena cava filter placement during percutaneous endovenous intervention for proximal lower extremity deep venous thrombosis: a retrospective study

Background Anticoagulant therapy is still the prevalent treatment for venous thromboembolism. In the new era of percutaneous endovenous intervention, there is a progressive increase in the use of percutaneous endoluminal clot dissolution techniques such catheter-directed thrombolysis (CDT) and mechanical aspiration thrombectomy devices because of their short-term advantages. Prophylactic deployment of inferior vena cava (IVC) filter during percutaneous endovenous therapy for lower extremity deep venous thrombosis (DVT) is still a debatable issue. Objectives The aim of our study is to assess retrospectively the frequency of embolization and the need for deployment of a retrievable IVC filter during endovenous treatment of proximal lower extremity DVT using percutaneous CDT and AngioJet pharmacomechanical thrombectomy (PMT) techniques. Settings and design This was a retrospective study. Patients and methods Percutaneous endoluminal clot dissolution using either CDT or AngioJet PMT for proximal lower extremity DVT was performed on 56 patients (59 limbs) of 187 patients diagnosed with proximal acute/subacute DVT in the Vascular Surgery Department of the study hospitals. An IVC filter was deployed in 29 patients before or during the procedure. Results Of 56 patients who were treated for proximal DVT with clot debulking procedures, the IVC filter was prophylactically deployed in 26 (46.4%) patients. Trapped thrombus in the deployed filters as shown on venocavography was observed in 9/26 (34.6%) filters deployed prophylactically, with an overall rate of thrombus embolization during percutaneous endovenous thrombus dissolution techniques being 12/56 (21.4%) patients. Conclusion CDT could be performed safely and effectively without routine prophylactic IVC filter placement in the treatment of acute DVT. Selective filter placement may be considered in patients undergoing PMT or patients with more proximal thrombus patterns with multiple risk factors.

Percutaneous mechanical thrombectomy in acute and subacute lower-extremity ischemia: impact of adjunctive, solely nonthrombolytic endovascular procedures

We aimed to evaluate the role of adjunctive, solely nonthrombolytic endovascular therapy in treatment of acute lower-extremity ischemia by rotational percutaneous mechanical thrombectomy. A retrospective, single-center evaluation of 165 patients (167 limbs) that underwent rotational percutaneous mechanical thrombectomy between 2009 and 2016 was performed. Rotational percutaneous mechanical thrombectomy was used as a single therapy in 9.0% (15 limbs), followed by percutaneous aspiration thrombectomy in 6.0% (10 limbs), percutaneous transluminal angioplasty in 19.8% (33 limbs) and stenting in 25.7% (43 limbs). Rotational percutaneous mechanical thrombectomy was followed by any combination of these three interventions in 39.5%. Clinical and technical success was documented in 92.2%, complications in 10.3% (n=17). No significant difference in clinical and technical success was observed using rotational percutaneous mechanical thrombectomy alone or with additional endovascular therapy. On a long-term basis, the re-ischemia-free survival was nearly twice as high as in previous studies that reported more cases treated by rotational percutaneous mechanical thrombectomy alone. To assure a long-lasting primary patency after percutaneous mechanical thrombectomy, concomitant treatment of underlying lesions with adjunctive, nonthrombolytic endovascular methods should be considered.

Indication of non-surgical management for acute limb ischemia

Acute Limb Ischemia (ALI) is a sudden decrease in limb perfusion that has a potential threat of life and limb viability. Although, surgical thrombectomy using an occlusion catheter (Fogarty catheter) has been traditionally performed as the standard approach for ALI, endovascular treatment (EVT) has recently been developed as an alternative to surgical revascularization. However, its indication remains unclear. We reviewed the indication of conventional treatments and introduced our original technique. There are several non-surgical treatments for ALI such as Percutaneous Aspiration Thrombectomy (PAT), Catheter-Directed Thrombolysis (CDT), angioplasty and stenting. PAT is effective for the patients with ALI in small vessels such as below-the-knee arteries. CDT is recommended for Rutherford grade I patients. Angioplasty and stent implantation, which is a well-established strategy in peripheral arterial disease, is applicable for the ALI patients in any Rutherford grade. We previously reported an endovascular technique using a guide extension catheter in the non-stenting zone for ALI, which is named “Temporary Endoluminal Bypass (TEB) technique”. This technique is based on the concept of a perfusion catheter and applied for a treatment of ALI. This technique is composed of 3 steps. First, we measure the lesion length. Second, we deliver the guide extension catheter to fully cover the lesion. Finally, we confirm the distal blood flow by angiography. Subsequently, urokinase (10,000 U/hr) is selectively administered to the vessel from the sheath. The endpoint of thrombolysis is determined by the achievement of antegrade blood flow after removal of the guide extension catheter. TEB technique is basically recommended for the ALI patients with Rutherford grades IIa and IIb. TEB technique may be an alternative treatment option for ALI although further investigation is needed.

EMERGENT THROMBECTOMY OF HIGH RISK PE

SESSION TITLE: Fellows Pulmonary Vascular Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Some physiologic consequences of high risk pulmonary emboli (PE), such as shock and refractory hypoxemia, require urgent reperfusion therapy. Delaying management in those cases may lead to catastrophic consequences including hemodynamic collapse. However, comorbid conditions often limit treatment options complicating management. Here we present two cases of acute onset severe hypoxemia attributable to PE. Neither patient was a candidate for pharmacological thrombolysis due to recent or active GI bleeding. CASE PRESENTATION: Patient A, a 52-year-old male with prior colectomy due to ulcerative colitis, was admitted with duodenal perforation and post-ERCP pancreatitis with one day of significant dyspnea and hypoxemia. He underwent testing with a computed tomography pulmonary angiogram (CTPA) which revealed pulmonary emboli. Despite intubation, FiO2 of 100%, recruitment maneuvers, and inhaled vasodilator therapy with epoprostenol, he had persistent and refractory hypoxemia (Table). After the initiation of heparin, he had recurrent gastrointestinal hemorrhage and required vasopressors. Patient B, a 71-year-old female with multiple myeloma and on chemotherapy with pancytopenia and lower GI bleed two weeks prior, presented with acute onset of dyspnea for less than one day and high oxygen requirements and labile hemodynamics with signs of hypoperfusion (Table). CTA confirmed pulmonary emboli. Point of care ultrasonography demonstrated signs of right heart strain. DISCUSSION: Both patients had bilateral pulmonary emboli and filling defects in distal left main pulmonary artery extending into left upper and lower lobar arteries and lobar and segmental arteries on the right. After rapid discussion with a multidisciplinary PE response team, percutaneous aspiration thrombectomy via the FlowTriever System was utilized in both patients. The FlowTriever System is a large bore catheter device which is FDA approved for mechanical thrombectomy in the pulmonary arteries. Both patients were successfully treated with acute clinical and technical success, with intraprocedural improvements of mean pulmonary artery pressures of > 25%. Patient A had immediate improvement of hypoxemia. Patient B had improvement in her hemodynamic stability and organ perfusion. Both patients did require packed red blood cell transfusions. This is partially attributed to both patients having active GI bleeding, but can be exacerbated aspiration of blood during thrombectomy if multiple passes are required. CONCLUSIONS: Percutaneous thrombectomy is an alternative treatment option in critically ill patients with high risk of hemodynamic collapse or refractory hypoxemia, especially in those with contraindications to thrombolysis. One limitation is the possibility of intraprocedural blood loss which should be anticipated and address with volume expansion with or without transfusion. Reference #1: Marshall PS, Mathews KS, Siegel MD. Diagnosis and management of life-threatening pulmonary embolism. J Intensive Care Med. 2011;26(5):275-294. doi:10.1177/0885066610392658 Reference #2: Wible BC, Buckley JR, Cho KH, Bunte MC, Saucier NA, Borsa JJ. Safety and Efficacy of Acute Pulmonary Embolism Treated via Large-Bore Aspiration Mechanical Thrombectomy Using the Inari FlowTriever Device. J Vasc Interv Radiol. 2019;30(9):1370-1375. doi:10.1016/j.jvir.2019.05.024 DISCLOSURES: No relevant relationships by Brian Cody Adkinson, source=Web Response Consultant relationship with Bellerophon Please note: $1001 - $5000 Added 06/01/2020 by Roger Alvarez, source=Web Response, value=Travel Advisory Committee Member relationship with United Therapeutics Please note: $1001 - $5000 Added 06/01/2020 by Roger Alvarez, source=Web Response, value=Consulting fee No relevant relationships by Adhiraj Gosine, source=Web Response No relevant relationships by Susanna Leonard, source=Web Response

AngioJet Aspiration Thrombectomy Combined with Transcatheter Thrombolysis in Treatment of Acute Portal Venous Systemic Thrombosis

This study set out to assess the feasibility, effectiveness, and safety of percutaneous AngioJet aspiration thrombectomy combined with transcatheter thrombolysis for treating acute portal venous systemic thrombosis (APVST). Clinical data of 13 patients with APVST who were treated by AngioJet aspiration thrombectomy combined with transcatheter thrombolysis from March 2017 to July 2018 were analyzed retrospectively. The effect of portal venous recanalization was evaluated by intraoperative angiography and postoperative surveillance of clinical findings, portal venous ultrasound, or computed tomography. Successful puncture of the portal vein (PV) was performed in all patients. The PV was punctured successfully in 7 patients via the transjugular intrahepatic route, 2 patients failed to be punctured and then had successful percutaneous transhepatic puncture, and 4 patients underwent percutaneous transhepatic PV puncture directly. The duration of thrombus aspiration was 238.46±89.89sec (range, 120-360), and the amount of urokinase in thrombus aspiration was 353,000±87,700 IU (range, 200,000-400,000). Portal venous thrombosis was dissolved by the AngioJet thrombectomy device (Boston Scientific, Marlborough, MA) in all patients. After aspiration, angiography showed that grade III lysis was achieved in 8 patients, grade II lysis in 1 patient, and grade I lysis in 4 patients. The length of transcatheter thrombolysis was 3.07±1.75days (range, 1-7), and the total urokinase dose via an indwelling catheter was 1,230,000±706,000 IU (range, 200,000-2,800,000). Four patients had a transjugular intrahepatic portosystemic shunt, 1 patient with stenosis of the superior mesenteric vein (SMV) achieved balloon angioplasty, and 1 patient with stenosis of the SMV was stented. Operative complications were transient hematuria (4 patients), palpitation (1 patient), and bowel resection (1 patient). No patients died within 30days. Patients were discharged at 12.00±5.83days (range, 6-27) after admission. All patients survived, and no recurrence developed during the follow-up of 9.15±3.18months (range, 4-15). Percutaneous AngioJet aspiration thrombectomy combined with thrombolytic therapy is feasible and effective for APVST. This treatment is beneficial for APVST in dissolving thrombus, improving SMV flow, and relieving symptoms of PV hypertension.

Safety and Efficacy of the Percutaneous Manual Aspiration Thrombectomy Technique to Treat Thrombotic Occlusion of Native Arteriovenous Fistulas for Hemodialysis

목적혈액투석용 자가혈관 동정맥루의 혈전을 동반한 폐색에서 경피적 수동 흡인 혈전제거술의 안전성과 유용성에 대해 평가하고자 한다.대상과 방법2012년 3월부터 2017년 12월까지 자가혈관 동정맥루의 혈전을 동반한 폐색으로 내원하여 경피적 혈관 내 시술을 시행 받은 20명의 환자를 후향적으로 분석하였다. 기술적 및 임상적 시술 성공률, 1차 및 2차 개통률, 그리고 시술에 따른 합병증을 분석하였다.결과총 20명의 환자에서 20회의 경피적 혈관 내 시술을 시행하였다. 모든 환자에서 혈전을 제거하기 위해 경피적 수동 흡인 혈전제거술을 시행하였고, 협착이 동반된 경우 풍선카테터를 이용한 혈관성형술을 함께 시행하였다. 17명의 환자는 혈전이 제거되어 혈류가 정상적으로 회복되었고(기술적 성공률 85%), 17명 환자 모두 시술 직후 혈액투석이 정상적으로 시행되었다(임상적 성공률 85%). 동정맥루 위치는 좌측 요골두정맥루가 13명, 좌측 상완두정맥루가 4명, 우측 요골두정맥루가 3명이었다. 동반된 협착 부위는 문합부 주위 정맥이 16예, 원위부 배출정맥이 12예, 중심정맥이 4예였다. 1차 및 2차 개통률은 1, 3, 6, 12개월에서 각각 100%, 70.6%, 70.6%, 56.5% 및 100%, 94.1%, 94.1%, 86.9%였다. 시술과 관련된 합병증은 없었다.결론혈액투석용 자가혈관 동정맥루에서 혈전을 동반한 폐색의 치료로서 경피적 수동 흡인 혈전제거술은 안전하고 유용한 시술이다.

Results of endovascular interventions in acute lower limb ischemia

The aim — to analyze the results of the use of endovascular revascularization methods for acute lower limb ischemia (ALLI) caused by thromboses or embolisms of the lower limb arteries.Materials and methods. An evaluation of the results of revascularization with the use of endovascular interventions in 108 patients with ALLI was performed. Depending on the treatment method, patients were divided into two groups. The first group included 78 patients who had intra‑arterial catheter‑directed thrombolysis, the second group included 30 patients after percutaneous aspiration or mechanical thrombectomy. If hemodynamically significant residual stenoses of arteries which caused thrombosis remained after thrombolysis or percutaneous thrombectomy, balloon angioplasty or stenting were used.Results and discussion. Technical success was achieved in 73 % of patients who underwent thrombolysis. Endovascular or surgical interventions in addition to thrombolysis were performed in 45 % of patients. The number of perioperative complications was 27 %, of which hemorrhagic — 14 %, including intracranial hemorrhages — 3 %. The number of larger amputations was 21 %, mortality — 8 %. The technical success of aspiration thrombectomy was 83 %, mechanical thrombectomy — 100 %. In most cases additional endovascular interventions were required to eliminate residual stenoses.Conclusions. Endovascular revascularization is an effective method for the treatment of acute lower limb ischemia. Majority of patients after thrombolysis and percutaneous thrombectomy have residual stenotic lesions of arteries which caused thrombosis and require additional endovascular or surgical treatment.

Retraction: Percutaneous Aspiration Thrombectomy for Arterial Thromboembolism during Infrainguinal Endovascular Recanalization.

Retraction: Percutaneous Aspiration Thrombectomy for Arterial Thromboembolism during Infrainguinal Endovascular Recanalization.

Aspiration Thrombectomy versus Conventional Catheter-Directed Thrombolysis as First-Line Treatment for Noniatrogenic Acute Lower Limb Ischemia

PurposeTo examine the efficacy, safety, and procedural costs of percutaneous aspiration thrombectomy (PAT) as a first-line treatment for noniatrogenic acute lower limb ischemia (ALI) compared with conventional catheter-directed thrombolysis (CDT). Materials and MethodsAll patients who underwent endovascular intervention for ALI from January 2015 to August 2017 were included. Fifteen patients were treated with the use of primary PAT and 27 patients were treated with the use of primary CDT. The primary end point was complete thrombus clearance with improvement in Thrombolysis in Myocardial Infarction (TIMI) score. Adjunctive treatment for thrombus removal was considered to indicate technical failure. Treatment of underlying chronic disease was not considered to indicate technical failure. Procedural costs for each patient were calculated by itemizing all disposable equipment, facility overheads, and staff costs. ResultsOf the 15 primary PAT patients, technical success was achieved in 8 (53%); the remaining 7 (47%) required adjunctive CDT. Of the 27 primary CDT patients, technical success was achieved in 25 (89%); the remaining 2 (11%) required adjunctive PAT. There were 4 complications in the primary PAT group: 2 were procedure related and of a minor grade. There were 8 complications in the primary CDT group: All were procedure-related, including 2 major groin/retroperitoneal hemorrhage and 1 death from intracranial hemorrhage. Limb salvage was attained in all patients. There were no significant differences in average procedural costs per patient between the 2 groups. ConclusionsFirst-line use of PAT for endovascular treatment of ALI can reduce the need for CDT, with no significant cost difference.

Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy.

We aimed to describe ultrasonography (US)-guided percutaneous aspiration thrombectomy in pregnant women with iliofemoral deep vein thrombosis. This study included nine pregnant women with acute and subacute iliofemoral deep vein thrombosis, who were severe symptomatic cases with massive swelling and pain of the leg. Patients were excluded from the study if they had only femoropopliteal deep vein thrombosis or mild symptoms of deep vein thrombosis. US-guided percutaneous aspiration thrombectomy was applied to achieve thrombus removal and uninterrupted venous flow. The treatment was considered successful if there was adequate venous patency and symptomatic relief. Complete or significant thrombus removal and uninterrupted venous flow from the puncture site up to the iliac veins were achieved in all patients at first intervention. Complete relief of leg pain was achieved immediately in seven patients (77.8%). Two patients (22.2%) had a recurrence of thrombosis in the first week postintervention. One of them underwent a second intervention, where percutaneous aspiration thrombectomy was performed again with successful removal of thrombus and establishment of in line flow. Two patients were lost to follow-up after birth. None of the remaining seven patients had rethrombosis throughout the postpartum period. Symptomatic relief was detected clinically in these patients. Endovascular treatment with US-guided percutaneous aspiration thrombectomy can be considered as a safe and effective way to remove thrombus from the deep veins in pregnant women with acute and subacute iliofemoral deep vein thrombosis.

Effectiveness of Percutaneous Aspiration Thrombectomy for Acute or Subacute Thromboembolism in Infrainguinal Arteries

Effectiveness of Percutaneous Aspiration Thrombectomy for Acute or Subacute Thromboembolism in Infrainguinal Arteries

Endovascular Management for the Treatment of Pancreas Transplant Venous Thrombosis: A Single-Center Experience

PurposeTo investigate the safety and efficacy of mechanical thrombectomy used as a tool for graft rescue in patients with pancreas graft venous thrombosis (PGVT). Materials and MethodsGraft venous thrombosis was discovered in 36 (33%) of 110 patients who underwent pancreas transplantation. Percutaneous aspiration thrombectomy was performed in seven patients (mean age, 31 y; range, 15–36 y) who had complete or severe thrombosis of the splenic vein or superior mesenteric vein seen on postoperative computed tomography. ResultsSuccessful evacuation of PGVT was possible in six of seven patients; the thrombus was partially evacuated in one patient. In this patient, subsequent anticoagulation salvaged the graft, rendering primary and secondary technical success rates as 86% and 100%, respectively. As pancreas grafts were successfully functioning in all seven patients within 1 month after endovascular treatment, the clinical success rate was 100%. There were no procedure-related complications. At the last follow-up evaluation, all seven patients were alive with no graft loss (mean follow-up time, 9.4 mo; range, 3.6–22.2 mo). ConclusionsEndovascular treatment may be considered in patients with severe PGVT to prevent early graft loss.