[Percutaneous hydromechanical thrombectomy in acute and subacute lower limb ischemia].
OBJECTIVE
A prospective study should evaluate the primary and 2-year results of treating acute and subacute lower-limb ischemia with hydromechanical thrombectomy (HTE).


METHODS
Consecutively 64 patients, 12 with viable and 52 with threatening limb ischemia and onset of symptoms within 8 +/- 9 days, were treated and controlled for 24 months. An 8 F hydromechanical thrombectomy device (HTK), was used. It sucks and shreds the thrombi. The shredded particles are transported to the outside.


RESULTS
In 8 patients a total, in the others a partial restoration of the vessel lumen up to 70-50% was achieved in a mean time of 34 minutes. Residual thrombi, underlying atherosclerotic vessel disease and occluded arteries with a small diameter made adjunctive interventions (balloon angioplasty, percutaneous aspiration thrombectomy, lysis) necessary. Clinical symptoms and the ankle-brachial index improved significantly (p < 0.01). Primary patency was 72%, 70%, 67%, and 65%; the limb salvage rates were 81%, 78%, 75%, and 73% for one, 3, 12, and 24 months respectively. Device-induced complications did not occur.


CONCLUSIONS
The HTK allowed a rapid reduction of fresh thrombotic material without complications. In 78% of the cases adjunctive therapies are required for wall-adherent thrombi and when tibial vessels with smaller lumina are included. Long-term results are comparable to literature data for fibrinolytic or operative regimens. The advantage, however of the HTK seems to be the reduction of intervention time and intra-arterial dosage of fibrinolytic drugs.
Höpfner
W
W
Klinik für Diagnostische Radiologie und Neuroradiologie, Zentralklinikum Augsburg. wolfgang.hoepfner@gmx.de
Bohndorf
K
K
Vicol
C
C
Loeprecht
H
H
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000008:administration & dosage; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D013927:Thrombosis / Q000601:surgery*; D013997:Time Factors; D014654:Vascular Patency
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin