Percutaneous mechanical thrombectomy for limb graft occlusion after endovascular aneurysm repair: Results of a case series

Abstract

Objective: Limb graft occlusion (LGO) is a recognised complication after endovascular aneurysm repair (EVAR). We present outcomes of a case series of LGO treated by percutaneous mechanical thrombectomy (PMT).

Methods: Six male patients (mean age 70.5 ± 7.5 years) presented with LGO after EVAR (n = 4), fenestrated EVAR with an iliac branch device (n = 1), branched EVAR (n = 1). Median time to occlusion was 28.5(IQR 90) weeks; all occlusions were unilateral. The presenting symptom was intermittent claudication (n = 4), chronic limb-threatening ischaemia (n = 1) or acute limb ischaemia (n = 1). PMT was undertaken using the 10F Rotarex Rotational Excisional Atherectomy System (Becton, Dickinson and Company, Franklin Lakes, USA) with optional stenting/reline of the affected limb.

Results: LGO was cleared in all 6 cases by PMT with limb stenting (n = 4)/limb reline (n = 2)/outflow stenting (n = 2). Post-operatively, novel oral anticoagulant therapy supplemented prior antiplatelet therapy in all cases. Length of stay was 2 (IQR 19) days. All cleared limbs remain patent at median 15 (IQR 185) weeks follow-up.

Conclusion: This case series indicates that percutaneous mechanical thrombectomy is associated with high technical success rates and subsequent acceptable ensuing short-to-midterm patency. This approach is a valid alternative to surgical interventions in such cases, and represents our primary approach when LGO is encountered after EVAR.

Keywords: Endovascular aneurysm repair; Rotarex; limb graft occlusion; percutaneous mechanical thrombectomy; stent-grafts; surgical outcomes.