Controlled localized thrombolysis with the "turbo" trellis to treat acute arterial occlusions following major surgery.
OBJECTIVE
To present the management of acute arterial ischemia following major abdominal and orthopedic surgery using a percutaneous thrombectomy device and a low dose of thrombolytic agent.


METHODS
A 38-year-old woman with T-8 paraplegia from a traumatic fall developed pelvic osteomyelitis, for which a left hemipelvectomy, hysterectomy, and partial vaginal resection were performed. Twelve hours after the procedure, the patient developed an ischemic left leg. Computed tomographic angiography demonstrated an occlusion of the left external iliac and common femoral arteries. A Turbo Trellis percutaneous thrombectomy device was used to lyse the left external iliac artery thrombosis using 1 mg of tissue plasminogen activator infused between the proximal and distal occluding balloons of the device. Total dispersion time was 5 minutes. There was complete thrombus removal without any significant bleeding complications. At 6 months, the artery remains widely patent.


CONCLUSIONS
Combination therapy with mechanical thrombectomy devices and low dose thrombolytic agents can be used to treat acute arterial occlusions at a single setting. The increased speed of the Turbo Trellis may allow for smaller doses of thrombolytic agents and shorter treatment times.
Arko
Frank R
FR
Stanford University, California, USA. farko@stanford.edu
Lee
Eugene
E
Zarins
Christopher K
CK
Fogarty
Thomas J
TJ
D000328:Adult; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002404:Catheterization / Q000295:instrumentation*; D003131:Combined Modality Therapy; D018795:Device Approval; D004305:Dose-Response Relationship, Drug; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006428:Hemipelvectomy; D006801:Humans; D007044:Hysterectomy; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007511:Ischemia / Q000188:drug therapy*; D007866:Leg / Q000098:blood supply*; D010019:Osteomyelitis / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015607:Stents; D017131:Thrombectomy / Q000295:instrumentation*; D015912:Thrombolytic Therapy / Q000295:instrumentation*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D014621:Vagina / Q000601:surgery
D010959:Tissue Plasminogen Activator