Rheolytic thrombectomy: possibilities and first results.
The present study was undertaken to investigate the possibilities of using the method of rheolytic thrombectomy (hereinafter referred to as RTE) in surgical practice, and to assess its immediate outcomes in treatment of thromboses of arteries and veins of the lower extremities, as well as transjugular intrahepatic portosystemic shunts (hereinafter referred to as TIPS). We have gained experience in carrying out a total of 33 rheolytic thrombectomies with the help of the system JET 9000 (R) using the Xpeedior catheter in a total of thirty-one 43-to-87-year-old patients. Twenty-four interventions were performed for acute thromboses of arteries and shunts of the lower limbs, five - in patients presenting with floating thrombi in the inferior vena cava, and four operations were carried out in patients diagnosed with thrombosis of the segment after TIPS. In the group of the patients with thromboses of the arteries of the lower limbs (n=19), in 16 patients RTE resulted in restoration of >50% of the arterial lumen. In three patients of the same group, we managed to restore the lumen by only 50% and less. In the group of patients with thromboses of the shunts (n=5), RTE with a successful angiographic outcome was performed in three patients. In yet another patient, the lumen was restored only by 50%, and in a further one patient, the lumen of the shunt we failed to restore. Nineteen patients underwent a total of 13 balloon angioplasties (BA), 4 stenting interventions, and 2 regional thrombolytic procedures. Two patients after RTE and V A were subjected to postdilatational endarterectomy. In one patient RTE from the shunt was supplemented with plasty of its proximal anastomosis with a synthetic patch. In two patients, RTE was complicated by embolism of the deep femoral artery. In the group consisting of five patients diagnosed with floating thrombi of the inferior vena cava, a successful outcome was observed only in two. In patients presenting with thromboses of the stems following TIPS in all the cases we managed to completely restore patency of the shunts. Later on, three patients were found to have developed rethrombosis of the shunt. In two cases after RTE, haemolysis was observed to ensue, followed by the development of acute renal insufficiency. The remote results were followed up in the group of the patients with thromboses of the arteries and shunts of the lower limbs within the terms up to 24 months. Patency of the remodelled segments was preserved in seventeen patients (77.3%), and five patients (22.7%) were subjected to amputation of the affected lower extremity. Hence, the initial experience gained in using RTE gives certain hopes in treatment of patients presenting with acute arterial and venous thromboses of various localization, owing to its due safety, minimally invasive nature, and high efficiency, especially in patients with severe accompanying pathology.
Zatevakhin
I I
II
Paediatric Department, Russian State Medical University, Municipal Clinical Hospital No57, Moscow, Russia.
Shipovskiĭ
V N
VN
Zolkin
V N
VN
Nechaev
A I
AI
Piliposian
E A
EA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D005260:Female; D005268:Femoral Vein; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000601:surgery*