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. 2012:8:283-9.
doi: 10.2147/VHRM.S30819. Epub 2012 May 4.

Percutaneous mechanical thrombectomy for treatment of acute femoropopliteal bypass occlusion

Michael Lichtenberg  1 , Matthias Käunicke, Birgit Hailer
Affiliations

Percutaneous mechanical thrombectomy for treatment of acute femoropopliteal bypass occlusion

Michael Lichtenberg et al. Vasc Health Risk Manag. 2012.

Abstract

Acute and subacute ischemia of the legs in acute and subacute femoropopliteal bypass occlusion is a dramatic situation that endangers the survival of the limbs, depending on the severity of the ischemia. Different therapy options like percutaneous mechanical thrombectomy procedures, which include rotational thrombectomy, have become available in recent years, in addition to local lysis and surgical thrombectomy. Surgical thrombectomy using the Fogarty catheter technique, in particular, shows an increased incidence of perioperative complications but only small technical success rates in randomized trials. On the other hand, local lysis is associated with increased costs due to resource-consuming measures, such as intensive monitoring and repeat angiographies, in addition to bleeding complications. In the past, further development of the Straub Rotarex(®) system as an endovascular therapy option has demonstrated good success leading to amputation-free survival in multiple studies. At the same time, a low rate of complications with use has been documented. Most examinations have been conducted in the thigh. To date, there are little investigational data on its use in acutely and subacutely occluded femoropopliteal bypasses. In this paper, the current study-based significance of the Rotarex system for this indication is analyzed based on the existing literature and the authors' own experiences with 22 patients.

Keywords: acute limb ischemia; femoropopliteal bypass; local lysis; rotational thrombectomy.

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Figures

Figure 1
Figure 1
The Rotarex® system.
Figure 2
Figure 2
Contraindications for Rotarex® use.
Figure 3
Figure 3
Acute proximal occlusion of a femoro-popliteal bypass on right.
Figure 4
Figure 4
Reperfusion after two rotation thrombectomy passes.
Figure 5
Figure 5
Detection of a high-grade insertion stenosis of the bypass as the presumed cause of the occlusion.
Figure 6
Figure 6
Normal flow in the bypass following stent percutaneous transluminal angioplasty.
Figure 7
Figure 7
Degeneratively altered femoropopliteal venous bypass on right following acute reopening with rotation thrombectomy (Rotarex® 8 F). Notes: Large bypass aneurysm upstream of the distal anastomosis. Elimination of the aneurysm in two steps using a Viabahn® endoprosthesis.
See this image and copyright information in PMC

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