Acute embolic occlusions of the infrainguinal arteries: percutaneous aspiration embolectomy in 102 patients.

Abstract

Percutaneous aspiration embolectomy (PAE) was performed on acute embolic occlusions of infrainguinal arteries unrelated to percutaneous transluminal angioplasty or chronic atherosclerotic arterial occlusive disease. Of 102 patients, most (62.7% [n = 64]) had limb-threatening ischemia (stages III and IV according to the Fontaine classification); 86.3% (n = 88) had cardiac disease that caused the embolic occlusion. The clinical success rate was 87.3% (n = 89). Major complications occurred in 8.8% (n = 9) of the cases. The 30-day mortality was 3.9% (n = 4). In comparison with Fogarty-catheter embolectomy, PAE has a higher success rate and a lower mortality. PAE has several advantages: It is a simple technique with reduced invasiveness, combines a diagnostic and a therapeutic procedure, enables treatment of tibial and pedal vessels, and can be combined with all other angioplastic methods.

Recanalization of Acute and Subacute Femoropopliteal Artery Occlusions with the Rotarex Catheter: One Year Follow-up, Single Center Experience

“…Acute popliteal emboli in particular may be treated without any additional thrombolysis or even the need for balloon dilatation if there is no underlying or concomitant atherosclerotic lesion [2,15]. However, since in native arteries there seems to be rapid onset of thrombus organization thrombi start to become adherent to the vascular wall within a couple of days, rendering catheter aspiration without additional lysis difficult or insufficient.…”

“…Mechanical maceration [16,20,21] seems to give slightly better results than hydrodynamic approaches [1,3,7,22]. In some studies PTA also showed high success rates in the range of 90-95% [1][2][3][4]24]. However, additional thrombolysis was used in 71% [24] and 22% [4] of cases, respectively.…”

“…Four clinically irrelevant embolisms were left untreated. Four pseudoaneurysms detected at duplex ultrasound after 2 days at the puncture site were treated conservatively by ultrasound-guided compression [2] or thrombosed spontaneously [2].…”

“…The standard modality of surgical thrombectomy with the Fogarty balloon catheter technique for acute arterial occlusions has been replaced by percutaneous catheter techniques at many institutions. The simplest technique is percutaneous aspiration thrombectomy (PAT) for thrombus aspiration [1,2]. Alternatively catheter-directed pharmacologic thrombolytic therapy with or without additional catheter aspiration is used, particularly if the occlusion is already a few days or weeks old [3,4].…”

Percutaneous Aspiration Embolectomy in the Treatment of Acute Arterial Embolic Infrainguinal Vascular Occlusion

“…Since its introduction, percutaneous aspiration embolectomy (PAE) has become a well-known, widely accepted and frequently applied technique for the treatment of acute arterial embolic infrainguinal vascular occlusion in lower limb ischemia [4]. Though the technique is applied for more than 30 years there are limited data on the technical and clinical success rate and the rate of complications for this kind of treatment [5][6][7].…”