The Trellis Thrombectomy System in the Treatment of Acute Limb Ischemia

2003 ◽  
Vol 10 (2) ◽  
pp. 317-321 ◽  
Author(s):  
Karthikeshwar Kasirajan ◽  
Venkatesh G. Ramaiah ◽  
Edward B. Diethrich
Keyword(s):  
Thrombolytic Agent ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Graft Thrombosis ◽  
Percutaneous Mechanical Thrombectomy ◽  
Flow Restoration ◽  
Drug Dispersion ◽  
Thrombectomy Device ◽  
Distal Occlusion

Purpose: To report the use of a new percutaneous mechanical thrombectomy device in the treatment of acute limb-threatening ischemia. Technique: The Trellis Thrombectomy System is a 7-F drug dispersion catheter that features a treatment segment isolated by proximal and distal occlusion balloons, which help prevent distal embolization and systemic release of the infused thrombolytic agent. After inflating the distal balloon, the thrombolytic agent is infused and held at the target site by inflation of the proximal balloon. An oscillating dispersion wire optimizes dispersal of the thrombolytic agent as the thrombus is mechanically fragmented. The liquefied thrombus is then aspirated. Four consecutive patients with acute lower extremity ischemia secondary to bypass graft thrombosis were treated with the Trellis thrombectomy catheter. Overall, 95% of thrombus was successfully removed from the treatment zone, with no device-related complications. Only one patient required adjunctive thrombolytic therapy after thrombectomy with the Trellis device. Conclusions: The Trellis thrombectomy device is a safe and effective technique to isolate the infused thrombolytic agent in association with mechanical fragmentation for rapid blood flow restoration.

Occluded Infrainguinal Bypass Graft: Potential Source of Limb-Threatening Emboli

Vascular ◽  
2006 ◽  
Vol 14 (3) ◽  
pp. 156-160
Author(s):  
Ankur Chandra ◽  
Niren Angle
Keyword(s):  
Bypass Graft ◽  
Limb Ischemia ◽  
Treatment Modalities ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Graft Occlusion ◽  
Graft Thrombosis ◽  
Peripheral Embolization ◽  
Surgical Bypass ◽  
Peripheral Arterial

Surgical bypass represents one of the chief treatment modalities for peripheral arterial occlusive disease. Despite improving techniques, graft occlusion accounts for the majority of these bypass failures. Once occluded, however, these grafts are thought to rarely pose a threat for future ischemic events. This report describes two patients with previously thrombosed grafts who subsequently presented with limb-threatening ischemia owing to peripheral embolization from the graft. Two patients with occluded grafts presented with ipsilateral limb-threatening acute ischemia. Both of these patients developed severe acute limb-threatening ischemia weeks to months after known graft thrombosis. Arteriography revealed peripheral embolization in each case. Both patients were operated on for disconnection of the thrombosed graft from the native circulation and have been free of recurrent symptoms. The occluded graft, although generally innocuous, can be a source of peripheral emboli, resulting in peripheral embolization and acute limb ischemia. Both patients in this report developed limb-threatening ischemia owing to embolization from the cul-de-sac of occluded prosthetic grafts. Due to the rarity of the condition and its associated morbidity and mortality, awareness and recognition of this phenomenon are critical. Operative disconnection is recommended if the embolism occurs downstream of the graft and no other embolic source can be identified.

scholarly journals Endovascular approach for acute limb ischemia without thrombolytic therapy

2020 ◽  
Vol 14 ◽  
pp. 175394472092457
Author(s):  
Keisuke Fukuda ◽  
Yoshiaki Yokoi
Keyword(s):  
Mortality Rate ◽  
Endovascular Therapy ◽  
Thrombolytic Agent ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Surgical Revascularization ◽  
Technical Success Rate ◽  
Kaplan Meier

Background: Endovascular therapy for acute lower limb ischemia (ALLI) has developed and demonstrated safety and efficacy. The purpose of this study was to assess clinical outcomes in patients treated for ALLI with conventional endovascular or surgical revascularization. Method: This study was a retrospective single-center review. Consecutive patients with ALLI treated with conventional endovascular revascularization (ER) without thrombolytic agent or surgical revascularization (SR) between 2008 and 2014 were investigated. The 1 year and 3 year amputation rate and mortality rate were assessed by time-to-event methods, including Kaplan–Meier estimation. Result: A total of 64 limbs in 62 patients with ALLI due to thromboembolism or thrombosis of a native artery, bypass graft, or previous stented vessel were included. The majority of limbs (90.9%) presented with Rutherford clinical categories 1 to 2 ischemia. Technical success rate was 95.5% in ER and 92.9% in SR group ( p = 0.547). Overall amputation rates were 9.1% in ER versus 9.5% in SR after 1 year ( p = 0.971) and 9.1% in ER versus 11.9% in SR after 3 year ( p = 0.742). Overall mortality rates were 15% in ER versus 7.1% in SR after 1 year ( p = 0.491) and 15% in ER versus 11.2% in SR after 3 year ( p = 0.878). Conclusion: Endovascular or surgical revascularization of ALLI resulted in comparable outcomes in limb salvage and mortality rate at 1 year and 3 year. Conventional endovascular therapy without thrombolytic agent such as stenting, balloon angioplasty, or catheter-directed thrombosuction may be considered as a treatment option for ALLI.

scholarly journals Preserved Renal Function in Kidney Transplantation over a Thrombosed Aortobifemoral Bypass Graft: The Role of Retrograde Flow and Early Thrombolysis

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Saúl Pampa-Saico ◽  
Sara Jiménez-Alvaro ◽  
Fernando Caravaca-Fontán ◽  
Ana Fernández-Rodríguez ◽  
Maite Rivera-Gorrín ◽  
...  
Keyword(s):  
Renal Function ◽  
Severe Renal Impairment ◽  
Imaging Techniques ◽  
Bypass Graft ◽  
Graft Loss ◽  
Previous History ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Retrograde Flow ◽  
Aortobifemoral Bypass

Aortobifemoral bypass (ABFB) thrombosis is not uncommon, and when the artery of a renal graft is implanted on a bypass the risk of graft loss is high. We report the case of a 48-year-old woman with a previous history of ABFB under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment. Imaging techniques revealed a complete thrombosis of the proximal left arm of the ABFB. However, a faint retrograde flow over the graft was observed thanks to the recanalization of distal left bypass by collateral native arteries. This unusual situation not previously reported in a kidney transplant setting, together with an early diagnosis, allowed graft survival until an early local thrombolysis resolved the problem. Two years later, renal function remains normal.

Advanced treatment of acute femoropopliteal bypass graft occlusion with Fogarty catheter guidance

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 262-266 ◽  
Author(s):  
Gokhan Albayrak ◽  
Koray Aykut ◽  
Mehmet Guzeloglu ◽  
Aytac Gulcu ◽  
Eyup Hazan
Keyword(s):  
Bypass Graft ◽  
Limb Ischemia ◽  
Graft Patency ◽  
Transluminal Angioplasty ◽  
Acute Limb Ischemia ◽  
Graft Occlusion ◽  
Fogarty Catheter ◽  
Femoropopliteal Bypass ◽  
Conventional Angiography ◽  
Stent Grafting

Purpose The guiding role of the Fogarty catheter was investigated among patients suffering from limb ischemia due to acute femoropopliteal bypass graft occlusion. Methods A total of 27 patients with a history of femoropopliteal bypass operation who was admitted with acute limb ischemia were enrolled in this retrospective study. In cases in which the Fogarty catheter could not be passed through the popliteal anastomosis, the popliteal region was explored and a new bypass or patch plasty was performed for the distal anastomosis. The cases in which the blood circulation was observed in the graft, but in which the Fogarty catheter balloon was stuck in the native vessels on the proximal and distal side of the graft and the balloon could be withdrawn by deflation, were referred to conventional angiography. The stenosis observed in native vessels was managed by endovascular stent grafting and/or balloon dilatation. Findings Graft patency was achieved in all patients. In 11 patients, conventional angiography was implemented following embolectomy. In these patients, all the occlusions found as significant on angiography were removed by percutaneous transluminal angioplasty. Conclusion Effective use of Fogarty catheter is safe in acute femoropopliteal bypass graft occlusions and in particular, in the planning of further treatment following thrombectomy.

Acute Limb Ischemia

2012 ◽  
Author(s):  
Jovan N. Markovic ◽  
Cynthia K. Shortell
Keyword(s):  
Clinical Evaluation ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Heparin Therapy ◽  
Common Symptom ◽  
Acute Limb Ischemia ◽  
Graft Occlusion ◽  
Surgical Embolectomy

Acute limb ischemia (ALI) is one of the most challenging conditions in vascular surgery and carries a high risk of amputation and mortality when treatment is delayed. Limb ischemia occurs when there is abrupt interruption of blood supply to an extremity because of either embolic or in situ thrombotic arterial or bypass graft occlusion. The goals of management include limb salvage, minimization of morbidity, and prevention of death. However, given that no objective markers of limb viability are currently available, the initial determination of whether a limb is likely to be viable must be made on clinical grounds. An early clinical evaluation is crucial for the diagnosis and identification of the underlying etiology of the ALI. As ALI is a clinical diagnosis, this review describes all aspects of the clinical evaluation as essential: patient history, staging of limb ischemia, and investigative studies. Atheromatous embolization is also discussed in depth. The characteristic signs of ALI may be summarized as the “six p’s”: pulselessness, pain, pallor, poikilothermia, paresthesia, and paralysis. Pain is the most common symptom in an ischemic limb and progresses along with the ischemia. As ischemia continues to progress, severe pain can be replaced by anesthesia of the limb, which can confound the examiner. Thus, pain should be documented with regard to severity, localization, and progression. ALI therapies covered are heparin therapy, thrombolytic therapy, thrombectomy, and surgical embolectomy and revascularization. The pathophysiology of limb ischemia is related to the progression of tissue infarction and irreversible cell death. Compared with other organs and tissues (e.g., the brain and the heart), the extremities are relatively resistant to ischemia. However, the various tissue types of which an extremity is composed have different metabolic rates. This review has 2 figures, 6 tables, and 165 references.

scholarly journals Catheter-directed thrombolysis versus percutaneous mechanical thrombectomy in the management of acute limb ischemia: a single center review

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Ravi Kumar Muli Jogi ◽  
Karthikeyan Damodharan ◽  
Hing Lun leong ◽  
Allison Chek Swee Tan ◽  
Sivanathan Chandramohan ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Single Center ◽  
Percutaneous Mechanical Thrombectomy ◽  
Catheter Directed Thrombolysis

scholarly journals Percutaneous Mechanical Thrombectomy Using Rotarex® S Device in Acute Limb Ischemia in Infrainguinal Occlusions

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Samuel Heller ◽  
Jean-Claude Lubanda ◽  
Petr Varejka ◽  
Miroslav Chochola ◽  
Pavel Prochazka ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Limb Ischemia ◽  
Performance Outcomes ◽  
Amputation Rate ◽  
Acute Limb Ischemia ◽  
Line Treatment ◽  
First Line ◽  
Invasive Treatment ◽  
Percutaneous Mechanical Thrombectomy ◽  
First Line Treatment

Purpose. To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. Methods. In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis. Additional fibrinolysis and adjunctive aspirational thrombectomy were utilized for outflow occlusion when required. Procedural outcomes, amputation rate, and mortality at 30 days were evaluated. Results. Of the 147 patients treated with mechanical thrombectomy, Rotarex S was used as first-line treatment in 120 cases and as second-line treatment in 27 cases. Overall, we achieved 90.5% procedural revascularization success rate when combining mechanical thrombectomy with limited thrombolysis for severe outflow obstruction, and 1 death and 3 amputations were observed. We achieved primary success in 68.7% of the patients with the mechanical thrombectomy only, and in 21.8% of the patients, we successfully used additional limited thrombolysis in the outflow. The overall mortality was 0.7% and amputation rate was 2% at 30 days. Conclusion. Percutaneous mechanical thrombectomy as first-line mini-invasive treatment in infrainguinal ALI is safe, quick, and effective, and the performance outcomes can be superior to that of traditional surgical embolectomy.

scholarly journals AngioJet® rheolytic thrombectomy for acute superficial femoral artery stent or femoropopliteal by-pass thrombosis

2015 ◽  
Vol 74 (2) ◽  
Author(s):  
Francesco Borgia ◽  
Luigi Di Serafino ◽  
Anna Sannino ◽  
Giuseppe Gargiulo ◽  
Gabriele Giacomo Schiattarella ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Limb Ischemia ◽  
Percutaneous Treatment ◽  
Acute Limb Ischemia ◽  
Ptfe Graft ◽  
Graft Thrombosis ◽  
Nitinol Stents ◽  
Rheolytic Thrombectomy

Thrombosis of superficial femoral artery (SFA) nitinol stents or polytetrafluoroethylene (PTFE) femoropopliteal bypass grafts after discontinuation of antiplatelet therapy is an emergent clinical challenge of acute limb ischemia (ALI), requiring immediate percutaneous intervention. Currently, there is no evidence-based approach for the management of such complications. We describe the cases of two patients presenting with ALI due to nitinol stent thrombosis after discontinuation of antiplatelet therapy and the case of a patient presenting with ALI due to PTFE femoropopliteal graft thrombosis in which limb salvage was obtained by AngioJet® rheolytic thrombectomy and re-stenting. In both cases, the thrombus was successfully removed using the Possis AngioJet® mechanical thrombectomy catheter and percutaneous transluminal angioplasty (PTA) was performed to recanalize two femoropopliteal nitinol stents and a femoropopliteal PTFE graft. In both cases, optimal angiographic result was obtained. To the best of our knowledge, these are the first three cases reporting the use of the AngioJet rheolytic thrombectomy in ALI due to stent or graft thrombosis. Taken together, these cases suggest that AngioJet® rheolytic thrombectomy might represent a novel effective strategy in the percutaneous treatment of stent or graft thrombosis determining ALI.

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