Thrombolysis of occluded femoropopliteal graft with locally delivered human plasmin

Introduction. Acute lower limb ischemia results from thrombosis or embolization of diseased native artery or previously implanted bypass graft. When this occurs, several options are available to restore blood flow: catheter-directed thrombolysis, mechanical thrombectomy or open surgery. Fundamental reasons to apply percutaneous interventions are avoiding open procedures in high risk patients, and avoiding difficult dissection through scar tissue. Case Outline. A 67-year-old male was admitted at our Institution for critical limb ischemia. After performed angiography the diagnosis of occluded femoropopliteal graft was established. Occlusion was resolved by catheter-directed thrombolysis with plasmin. Culprit lesions were treated by angioplasty. Conclusion. Our patient underwent a successful thrombolysis of occluded femoropopliteal graft with locally-delivered human plasmin.

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A comparison of outcomes based on vessel type (Native artery vs. bypass graft) and artery location (Below-knee artery vs. non-below-knee artery) using a combination of multiple endovascular techniques for acute lower limb ischemia

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.02.023 ◽

2021 ◽

Author(s):

Tatsuo Ueda ◽

Hiroyuki Tajima ◽

Satoru Murata ◽

Hidemasa Saito ◽

Daisuke Yasui ◽

...

Keyword(s):

Lower Limb ◽

Bypass Graft ◽

Limb Ischemia ◽

Endovascular Techniques ◽

Lower Limb Ischemia ◽

Native Artery

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COVID-19 Related Acute Lower Limb Ischemia Treated Via Percutaneous Thrombectomy and Catheter Direct Thrombolisis

Angiology & Vascular Surgery ◽

10.24966/avs-7397/100080 ◽

2021 ◽

Vol 6 (3) ◽

pp. 1-7

Author(s):

Francesco De Santis ◽

Keyword(s):

Popliteal Artery ◽

Lower Limb ◽

Mechanical Thrombectomy ◽

Limb Ischemia ◽

High Rate ◽

Lower Limb Ischemia ◽

Percutaneous Mechanical Thrombectomy ◽

Selective Approach ◽

Catheter Directed Thrombolysis ◽

Angio Ct

Background: The aim of this report is to describe and discuss a unique case of acute lower limb ischemia presented in a recovered COVID-19 patient treated via percutaneous mechanical thrombectomy and catheter directed thrombolysis. Starting from this singular case a wide literature review regarding COVID-19-related thrombo-embolic complications has been accomplished. Methods: A 47-year-old male was admitted to the emergency unit with acute lower limb ischemia three weeks after testing positive for COVID-19. He had been isolated at home because of minor COVID-19-related symptoms. Angio-CT-imaging showed a segmental occlusion of the common iliac artery coupled with retro-articular popliteal artery and leg vessels thrombosis. The patient was first unsuccessfully submitted to trans-femoral iliac thrombo-embolectomy. Results: Instead of peripheral limb vessel re-thromboembolectomy, a percutaneous mechanical thrombectomy coupled with leg vessel catheter direct thrombolysis was performed. The completion angiography showed the recanalization of the popliteal artery and leg vessels as far as the ankle but with a reduced forefoot vascularization. The fibrinolytic treatment was continued for 8 hours post-operatively. A compartment syndrome complicated the early post-operative course. There was a progressive recovery of ischemic symptoms and at 6-month follow-up, peripheral pulses were palpable with an almost complete normalization of foot and toe perfusion and motility. Conclusion: Acute lower limb ischemia following COVID-19-related arterial thrombo-embolic events represents a severe complication of COVID-19 infection and may result in a high rate of revascularization failure. In these cases, Percutaneous Mechanical thrombectomy coupled with catheter directed thrombolysis might represent a less traumatic and more selective approach.

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