title: Mid-term follow-up after percutaneous hydrodynamic thrombectomy in lower limb ischemia: initial experience with two-dimensional MR imaging and three-dimensional MR angiography.
abstract: OBJECTIVE
  To assess noninvasively mid-term patency, reocclusion, and mid-term changes of the arterial wall after percutaneous hydrodynamic thrombectomy in patients with acute lower limb ischemia using magnetic resonance (MR) imaging/MR angiography (MRA).
  
  
  METHODS
  Arterial wall and luminal changes were evaluated in 16 patients (10 men, six women; mean age, 70 years), with a minimum follow-up of 12 months after percutaneous thrombectomy with a hydrodynamic catheter for acute lower limb ischemia (embolic, n = 5; thrombotic, n = 11). Adjunctive PTA was performed in 44%. The mean follow-up was 23 months +/- 7.6 (range, 12-33 months). MR imaging and MRA were performed on a 1.0 T system using an extremity coil and two-dimensional (2D) time-of-flight, turbo spin echo, 2D gradient echo, and contrast enhanced three-dimensional (3D) gradient echo sequences.
  
  
  RESULTS
  In one patient, a complete reocclusion was noted and, in two patients, a hemodynamically insignificant restenosis (< or = 50%) was identified with MR imaging. This was in accordance with color flow duplex sonography, physical examination, ankle/brachial index measurements, and the treadmill test. The MR morphometry documented an increase of the entire vessel area from 48.9 mm2 +/- 3.3 (control segments) to 55.5 mm2 +/- 2.8 at the treated segments (+13.3%; P < .05). The vessel wall area increased from 31.7 mm2 +/- 1.8 to 39.4 mm2 +/- 2.3 (+24.4%; P < .05). The mean area stenosis grade was 12%.
  
  
  CONCLUSIONS
  MR imaging with use of morphometric analysis is a possible tool to noninvasively determine the mid-term patency and restenosis/reocclusion and remodeling process after percutaneous thrombectomy and other interventional procedures.
authors.affiliation: Department of Diagnostic Radiology, University Hospital, Philipps-University, Marburg, Germany. kalinows@mailer.uni-marburg.de
authors.forename: M
authors.initials: M
authors.lastname: Kalinowski
authors.forename: J
authors.initials: J
authors.lastname: Heverhagen
authors.forename: H
authors.initials: H
authors.lastname: Alfke
authors.forename: K J
authors.initials: KJ
authors.lastname: Klose
authors.forename: H J
authors.initials: HJ
authors.lastname: Wagner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001783:Blood Flow Velocity; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex