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Percutaneous Mechanical Thromboembolectomy in Acute Lower Limb Ischemia
Dierk Vorwerk1, Stefan Triebe2, Steffen Ziegler2
1Department of Radiology, Klinikum Ingolstadt, Ingolstadt, Germany. Dierk.Vorwerk@klinikum-ingolstadt.de.
Cardiovascular and Interventional Radiology
|November 30, 2018
Summary
Mechanical thromboembolectomy effectively treats acute infrainguinal leg ischemia. Combining aspiration with rotational thrombectomy improves outcomes, as manual aspiration alone often fails, especially for above-knee occlusions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Acute lower limb ischemia (ALI) is a critical condition requiring prompt intervention.
- Percutaneous mechanical thromboembolectomy (PMT) offers a minimally invasive approach to ALI.
- Infrainguinal occlusions present unique challenges for recanalization.
Purpose of the Study:
- To evaluate the immediate outcomes of PMT for acute infrainguinal leg ischemia.
- To assess the efficacy of different mechanical thrombectomy techniques.
- To analyze patient characteristics and procedural success rates.
Main Methods:
- Retrospective analysis of 156 infrainguinal ischemic events in 148 patients.
- Categorization of patients by Rutherford classification (I, IIA, IIB).
- Primary technique: manual aspiration, supplemented with rotational thrombectomy (Rotarex) if needed; antegrade femoral artery access preferred.
Main Results:
- High technical success rate of 93% (145/156 procedures).
- Manual aspiration used in 98% of cases; rotational thrombectomy added in 38%.
- Significant clinical improvement in 86.5% of patients; early mortality was low and mostly unrelated to intervention.
Conclusions:
- PMT is a successful treatment for acute infrainguinal leg ischemia.
- Combining aspiration embolectomy with rotational thrombectomy is often necessary for successful recanalization.
- Manual aspiration alone is frequently insufficient, particularly for occlusions above the knee.
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