Rheolytic thrombectomy: possibilities and first results

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Thrombotic occlusions of lower extremity arteries and veins, and TIPS present significant clinical challenges.
• Existing treatment modalities may have limitations in efficacy and invasiveness.

Purpose of the Study:

• To evaluate the feasibility and immediate outcomes of rheolytic thrombectomy (RTE) in managing acute thromboses.
• To assess RTE's effectiveness in lower extremity arteries/veins and TIPS.

Main Methods:

• 33 rheolytic thrombectomies performed using the JET 9000 system and Xpeedior catheter.
• Interventions targeted lower extremity arterial thromboses, inferior vena cava (IVC) floating thrombi, and post-TIPS thromboses.
• Adjunctive procedures included balloon angioplasty, stenting, and regional thrombolysis.

Main Results:

• Successful lumen restoration (>50%) achieved in 16/19 patients with lower extremity arterial thromboses.
• RTE achieved successful angiographic outcomes in 3/5 patients with TIPS thromboses.
• Complications included deep femoral artery embolism (2 patients) and acute renal insufficiency (2 patients) post-RTE.
• In lower extremity cases, 77.3% maintained patency at 24 months, with 22.7% requiring amputation.

Conclusions:

• Rheolytic thrombectomy (RTE) demonstrates safety, minimally invasive nature, and high efficiency for acute arterial and venous thromboses.
• RTE offers a promising option, particularly for patients with severe comorbidities.
• Careful patient selection and monitoring are crucial due to potential complications.