[Treatment of acute femoropopliteal bypass graft occlusion: comparison of mechanical rotational thrombectomy with ultrasound-enhanced lysis].
OBJECTIVE
Mechanical thrombectomy has become a viable alternative to intra-arterial thrombolysis for the treatment of acute infrainguinal occlusion. The aim of this prospective study was to evaluate the safety and effectiveness of a mechanical thrombectomy system in comparison with ultrasound-enhanced thrombolysis.


METHODS
From April 2005 to March 2007, 20 patients, mean age 67.4+/-13.6, with acute occlusions of the femoropopliteal bypass graft were treated with either a rotational thrombectomy system (Straub Rotarex, n=10) or with 1.0 mg/h Actilyse using an ultrasound-enhanced lysis system (EKOS Lysus Peripheral Catheter System, n=10). The mean occlusion length was 33.1 cm (range 28-40 cm) in the thrombectomy group and 33.7 cm (11-50 cm) in the lysis group.


RESULTS
The technical success rate was 100% in the thrombectomy group and 90 % in the lysis group. The mean treatment time was significantly lower with 64.5 min (45-90 min) in the thrombectomy group in comparison with 904.0 min (120-1350 min) in the lysis group. The ankle brachial index (ABI) improved in the thrombectomy group from 0.41+/-0.09 to 0.86+/-0.10 at discharge and 0.85+/-0.07 after 1 month (p<0.05) and in the lysis group from preinterventional 0.37+/-0.15 to 0.82+/-0.16 at discharge and 0.80+/-0.24 after 1 month (p<0.05). In one case lysis had to be stopped after two hours because of dislocation of the introducer sheath which was then treated by open surgery.


CONCLUSIONS
Mechanical-rotational thrombectomy with the Rotarex system and lysis with the ultrasound-enhanced catheter from Ekos were very safe and effective treatment options for acute occlusion. Blood flow is restored much faster with mechanical thrombectomy.
Wissgott
C
C
Radiologie, DRK-Kliniken Berlin, Berlin. cwissgott@gmx.de
Kamusella
P
P
Richter
A
A
Klein-Weigel
P
P
Schink
T
T
Steinkamp
H J
HJ
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D017131:Thrombectomy / Q000295:instrumentation*; D015912:Thrombolytic Therapy / Q000295:instrumentation*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D018084:Ultrasonography, Interventional / Q000295:instrumentation*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator