title: Percutaneous mechanical thrombectomy in the treatment of acute and subacute occlusions of the peripheral arteries and bypasses.
abstract: BACKGROUND
  The aim of this prospective single-centre study was to analyse the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries and bypasses, as well as to evaluate long-term outcomes of this method.
  
  
  METHODS
  Patients with acute (duration of symptoms < 14 days) or subacute (duration of symptoms > 14 days and < 3 months) occlusions of peripheral arteries and bypasses were selected consecutively for treatment. The cohort consisted of 113 patients, aged 18-92 years (median 72 years). In all, 128 procedures were performed.
  
  
  RESULTS
  Angiographic success was obtained in 120 interventions (93.8%). Reasons for failures were rethrombosis of a partially recanalised segment in six procedures, and embolism into crural arteries in one intervention--percutaneous aspiration thromboembolectomy (PAT) and/or thrombolysis were ineffective in all these cases. Breakage of the Rotarex catheter happened in one procedure. Embolisation into crural arteries as a transitory complication solvable with PAT and/or thrombolysis occurred in four cases. Rethrombosis was more frequent in bypasses than in native arteries (p = 0.0069), in patients with longer occlusions (p = 0.026) and those with poorer distal runoff (p = 0.048). Embolisation happened more often in patients with a shorter duration of symptoms (p = 0.0001). Clinical success was achieved in 82.5%. Major amputation was performed in 10% of cases. Cumulative patency rates were 75% after one month, 71% after six months, 38% after 12 months, 33% after 18 months and 30% after 24, 30, 36 and 42 months.
  
  
  CONCLUSIONS
  Rotarex thrombectomy has excellent immediate results with a low rate of failures and complications. In comparison to thrombolysis, it enables the fast and efficient treatment of acute and subacute occlusions of peripheral arteries in one session.
authors.affiliation: 1 Department of Radiology, District Hospital Kladno, Czech Republic.|2 Department Cardiology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Frantisek
authors.initials: F
authors.lastname: Stanek
authors.affiliation: 1 Department of Radiology, District Hospital Kladno, Czech Republic.
authors.forename: Radoslava
authors.initials: R
authors.lastname: Ouhrabkova
authors.affiliation: 1 Department of Radiology, District Hospital Kladno, Czech Republic.
authors.forename: David
authors.initials: D
authors.lastname: Prochazka
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D018153:Czech Republic; D004867:Equipment Design; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D015641:Radiography, Interventional; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014654:Vascular Patency; D055815:Young Adult
keywords: Rotarex thrombectomy; peripheral arteries; thromboembolic occlusions