Rheolytic thrombectomy, angioplasty, and selective stenting for subacute isolated popliteal artery occlusions.
OBJECTIVE
We have observed that some patients with isolated popliteal artery occlusions (PAOs) harbor varying degrees of organized clot, as suggested by the rapidity with which these occlusions are traversed with the Glidewire. We hypothesized that debulking such PAOs by using rheolytic thrombectomy without adjunctive thrombolysis before percutaneous transluminal angioplasty and selective stenting (PTA/S) is safe and enables single-session treatment with minimal risk of embolization.


METHODS
Between February 2004 and January 2007, 16 male patients (mean age, 68.9 +/- 11.1 years; range, 54-84 years) presenting with disabling claudication (n = 1), rest pain (n = 5), and tissue loss (n = 10; mean duration, 11 +/- 8 weeks; range, 4-26 weeks) were prospectively followed up after rheolytic thrombectomy and angioplasty and selective stenting of their PAO.


RESULTS
The mean occlusion length was 11.6 +/- 4.5 cm. After rheolytic thrombectomy, the occlusions were converted to long stenoses (mean length of 7.6 +/- 3.6 cm). Self-expanding stents were used in 10 of 16 (mean length of 8.3 +/- 4.4 cm). Additional recanalizations of occlusions of the iliac artery and proximal superficial femoral artery were performed before popliteal artery recanalizations in two patients. Ankle-brachial indexes increased from 0.27 +/- 0.22 to 0.94 +/- 0.13. No case of distal embolization was observed. Adjuvant thrombolysis was used in only one case to improve runoff. Inline flow to the foot was achieved in 15 of 16 cases. Three occlusions occurred at 3, 6, and 20 months after surgery (mean follow-up, 15.7 +/- 10.0 months), and two patients underwent successful thrombolysis. The third patient refused further intervention and remains a claudicant. One-year primary and secondary patency rates were 84% and 92%, respectively. Two limb losses occurred at 7 and 9 months as a result of recurrent foot infection in patients with diabetes, both with patent popliteal arteries (1-year limb salvage rate, 83%).


CONCLUSIONS
We advocate debulking isolated subacute PAOs with rheolytic thrombectomy when they are easily crossed, because this enables recanalization of these lesions in a single setting, thus obviating the additional need for thrombolysis in most cases, with seemingly minimal risk of distal embolization. This simple approach is effective and widely available.
Dosluoglu
Hasan H
HH
Division of Vascular Surgery, Department of Surgery, State University of New York at Buffalo, Buffalo, NY 14215, USA. dosluoglu@yahoo.com
Cherr
Gregory S
GS
Harris
Linda M
LM
Dryjski
Maciej L
ML
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D015607:Stents; D017131:Thrombectomy / Q000379:methods