[Femoro-popliteal emboli: treatment by manual thrombo-aspiration]

Acute arterial thrombo-embolic pathology constitutes a common pathology in the elderly population, principally in cases of cardiac arrhythmia. Out study allowed analysis of the results of percutaneous manual thrombo-aspiration as a primary procedure in a series of 25 patients (average age: 73.3 +/- 11.3 years) presenting with a picture of acute femoro-popliteal ischaemia, of supposed cardiac origin. Most of the patients had an arrhythmia with atrial fibrillation (68%), and 88% had grade II ischaemia. The site of proximal occlusion most frequently found was the popliteal axis (22 patients). Thrombo-aspiration was performed in all cases via the common femoral route homo-lateral with the ischaemia, by anterograde approach, after having obtained a diagnostic angiograph of the opposite side. The procedure, with an average duration of 39 minutes, allowed restoration of good quality flow in at least 2 axes subjacent to the occlusion in 23 patients (92%). Besides two failures, two complications (8%) were counted (one Scarpa haematoma and one early re-thrombosis). This good result was sustained long term, with 94% of patients reviewed on average 3 years after the procedure remaining asymptomatic. Manual thrombo-aspiration thus constitutes a technique of choice in the framework of the management of acute infra-inguinal emboli due to its angiographic and functional results on the one hand, and its low morbidity on the other, in a population particularly exposed to the risk of spontaneous and post-operative vascular complications.