J Korean Soc Radiol.  2017 Jun;76(6):386-394. 10.3348/jksr.2017.76.6.386.

Effectiveness of Percutaneous Aspiration Thrombectomy for Acute or Subacute Thromboembolism in Infrainguinal Arteries

• Cha JG
• Kim CS
• Kim YH
• Kim SH

• KMID: 2379320
• DOI: http://doi.org/10.3348/jksr.2017.76.6.386

Abstract

PURPOSE
To report the feasibility and long-term clinical outcome of percutaneous aspiration thrombectomy for treating acute or subacute arterial thromboembolism in the infrainguinal arteries.
MATERIALS AND METHODS
Thirty limbs of 29 patients were enrolled in this retrospective study between January 2004 and March 2014. Nine limbs underwent overnight catheter-directed thrombolysis followed by percutaneous aspiration thrombectomy (PAT). Eighteen limbs underwent PAT with adjunctive selective intra-arterial thrombolysis in a single session. The remaining three limbs underwent PAT alone. Balloon angioplasty (n = 16) or stent placement (n = 3) was performed as required. In-hospital mortality and complications were estimated. The primary patency rate and the rate of freedom from reintervention were calculated using the Kaplan-Meier method.
RESULTS
Technical success was achieved in 28 limbs. Clinical success was achieved in 27 limbs. The mean ankle-brachial index increased from 0.17 ± 0.26 to 0.98 ± 0.19 after the procedure. Three in-hospital deaths and no major amputations were recorded. Distal embolization of crural arteries occurred as a minor complication in five limbs, but no major complications occurred. The primary patency rate and the rate of freedom from reintervention were 74.9% and 90.9% at 1 year, respectively, and 66.6% and 80.8% at 2 years, respectively.
CONCLUSION
PAT is a rapid and effective method to remove a thrombus from occluded infrainguinal arteries.

MeSH Terms

Amputation
Angiography
Angioplasty, Balloon
Ankle Brachial Index
Arteries*
Endovascular Procedures
Extremities
Freedom
Hospital Mortality
Humans
Mechanical Thrombolysis
Methods
Peripheral Arterial Disease
Retrospective Studies
Stents
Thrombectomy*
Thromboembolism*
Thrombolytic Therapy
Thrombosis

Figure

• 

  Fig. 1. Flow chart of patient selection. ALLI = acute lower limb ischemia, CDT = catheter-directed thrombolysis, CTA = CT angiography, DUS = Doppler ultrasonography, PAT = percutaneous aspiration thrombectomy, UK = urokinase

• 

  Fig. 2. Angiograms of a 74-year-old male who presented with coldness and resting pain in the left leg for 7 days. He had undergone prior surgical embolectomy. Initial angiogram (A) shows occlusion from the distal superficial femoral artery (arrow) to the popliteal artery. Angiogram after aspiration of the thrombus and balloon angioplasty of the superficial femoral artery (B) reveals embolic occlusion of the crural arteries. After aspirating the thrombi in the crural arteries, the final angiogram shows good patency of the superficial femoral (C), proximal posterior tibial, and common peroneal arteries (D). Although the final angiogram of the foot (E) reveals distal embolization (arrow) at the distal posterior tibial artery, collateral flow is detected from the recanalized posterior tibial artery to the dorsalis pedis artery (arrowhead). Clinical success was achieved, and the ankle-brachial index increased from 0 to 1.16.

• 

  Fig. 3. Primary patency curves. PAT + CDT: overnight CDT followed by PAT group, PAT alone: PAT with/without adjuvant thrombolysis in a single session group. CDT = catheter-directed thrombolysis, PAT = percutaneous aspiration thrombectomy

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  Fig. 4. Freedom from reintervention curves. PAT + CDT: overnight CDT followed by PAT group, PAT alone: PAT with/without adjuvant thrombolysis in a single session group. CDT = catheter-directed thrombolysis, PAT = percutaneous aspiration thrombectomy

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