title: Foot Embolization During Limb Salvage Procedures in Critical Limb Ischemia Patients Successfully Managed With Mechanical Thromboaspiration: A Technical Note.
abstract: OBJECTIVE
  To illustrate the use of a mechanical thromboaspiration device originally designed for clot retrieval in acute stroke in the treatment of acute distal embolism occurring during percutaneous revascularization of the femoropopliteal and below-the-knee arterial segments.
  
  
  METHODS
  The Penumbra system was adapted for aspiration of thrombus in the distal foot arteries as a standalone device. The 2 over-the-wire, tapered lumen catheters have long working lengths (139 cm for the 4MAX to 153 cm for the 3MAX) that allow advancement below the ankle even with a retrograde contralateral approach. Once the occluded arterial segment is reached, the catheters are connected to the dedicated pump for continuous vacuum aspiration. The use of the device is illustrated in 3 diabetic patients (1 woman and 2 men; ages 88, 70, and 73 years, respectively) undergoing limb salvage procedures who experienced distal embolization that would have seriously jeopardized the foot circulation. The lumens of the occluded arteries were restored without complication.
  
  
  CONCLUSIONS
  While further evaluation in a larger cohort of patients is needed, this initial experience using the Penumbra system in the peripheral vasculature suggests that this is a rapid, effective approach to address intraprocedural foot embolization and avoid possible grave clinical sequelae.
authors.affiliation: Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, IRCCS Fondazione Policlinico di Tor Vergata, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gandini
authors.affiliation: Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, IRCCS Fondazione Policlinico di Tor Vergata, Rome, Italy stefanomerolla@yahoo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Merolla
authors.affiliation: Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, IRCCS Fondazione Policlinico di Tor Vergata, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Chegai
authors.affiliation: Hôpital Européen Georges-Pompidou, Université Paris V René Descartes, Paris, France.
authors.forename: Costantino
authors.initials: C
authors.lastname: Del Giudice
authors.affiliation: Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, IRCCS Fondazione Policlinico di Tor Vergata, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Stefanini
authors.affiliation: Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, IRCCS Fondazione Policlinico di Tor Vergata, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Pampana
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D017128:Embolectomy / Q000295:instrumentation*; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D023821:Limb Salvage; D008297:Male; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: acute ischemia; critical limb ischemia; distal embolization; endovascular revascularization; foot arteries; limb salvage; mechanical thrombectomy; thromboaspiration