title: Mechanical thrombectomy using Rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture - a case report and literature review.
abstract: BACKGROUND
  Treatment of peripheral arterial diseases may be distinguished into conservative and interventional management; the latter is divided into surgical and endovascular procedures. Management of peripheral artery stenosis and occlusion with vascular stents is associated with the risk of late complications such as restenosis, stent fracture or dislocation.
  
  
  METHODS
  A 62-year-old woman with generalized atherosclerosis, particularly extensive in lower limb arteries, was admitted to the Department of Angiology 11 months after having an endovascular procedure performed due to critical ischemia of left lower limb. Because of stent occlusion, a decision to perform angiographic examination of lower limb arteries was made. Examination revealed occlusion of the superficial femoral artery along its entire length, including previously implanted stents. Distal stent was fractured with slight dislocation of the proximal segment. A decision was made to perform mechanical thrombectomy using a Rotarex system followed by a stent-in-stent placement procedure. Follow-up angiography and ultrasound scan performed 24 hours after the procedure revealed a patent vessel with satisfactory blood flow.
  
  
  CONCLUSIONS
  Nowadays, imaging diagnostics of peripheral artery stenosis involves non-invasive examinations such as ultrasound, minimally invasive examinations such as angio-MRI and MDCT, or invasive examinations such as DSA and IVUS. DSA examinations are used to confirm significant stenosis or occlusion of a vessel, particularly when qualifying a patient for endovascular treatment. Due to their anatomic location, the superficial femoral artery and the popliteal artery are subject to various forces e.g. those exerted by the working muscles. Mechanical thrombectomy and atherectomy are efficient methods of arterial recanalization used in the treatment of acute, subacute or even chronic occlusions or stenosis of peripheral vessels.
  
  
  CONCLUSIONS
  Frequency of angioplasty and vascular stent implantation procedures is increased in patients with peripheral arterial disease, thus increasing the incidence of reported early and late complications such as acute stent thrombosis, restenosis and stent fractures. The Rotarex transcutaneous mechanical thrombectomy system is an efficient method of treating occlusions in arterial stents. It is also safe when performed by experienced operators.
authors.affiliation: Lower Silesian Diagnostic Imaging Centre, Regional Specialist Hospital in Wrocław, Research and Development Centre, Wrocław, Poland ; Wrovasc - Integrated Cardiovascular Centre, Wrocław, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Dys
authors.forename: Justyna
authors.initials: J
authors.lastname: Drelichowska-Durawa
authors.forename: Bartosz
authors.initials: B
authors.lastname: Dołega-Kozierowski
authors.forename: Michał
authors.initials: M
authors.lastname: Lis
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Sokratous
authors.forename: Wojciech
authors.initials: W
authors.lastname: Iwanowski
authors.forename: Stanisław
authors.initials: S
authors.lastname: Drelichowski
authors.forename: Wojciech
authors.initials: W
authors.lastname: Witkiewicz
keywords: femoral artery occlusion; mechanical thrombectomy; stent fracture