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Recanalisation of thrombotic arterial occlusions with rotational thrombectomy

Ricanalizzazione delle occlusioni trombotiche arteriose mediante trombectomia rotazionale

  • Vascular and Interventional Radiology / Radiologia Vascolare ed Interventistica
  • Published:
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Abstract

Purpose

This study sought to assess the effectiveness of rotational thrombectomy (RT) with the Rotarex device in the treatment of thrombotic occlusions in native arteries, by-pass grafts, stents and stent-grafts.

Materials and methods

Over the last 4 years, 22 patients (14 men and 8 women; mean age 62.6 years) affected by 5 acute (<14 days) thrombotic occlusions of the native arteries (4 plaque thromboses in the common iliac artery and one on a dissection intimal flap of the external iliac artery), 17 subacute and chronic thromboses affecting 4 femoro-popliteal by-pass grafts, 10 stents (7 in the common iliac artery and 3 in the superficial femoral artery) and 3 stents-grafts were studied. Acute thromboses of native arteries were follow-up with colour-Doppler ultrasound (US) examination at 1 and 3 months. Subacute and chronic thrombotic occlusions were follow-up with colour-Doppler US examination at 1, 3, 6 and 12 months and yearly thereafter.

Results

Immediate technical success was achieved without any need for additional procedures in all acute occlusions of native arteries (4/22 cases). In the subacute and chronic occlusions, the procedure was completed with percutaneous transluminal angioplasty (PTA) (8/22), cutting balloon (6/22) and stenting (5/22). The complication rate was 4.8% (1 rupture of the external iliac artery repaired with a stent-graft).

Conclusions

Arterial recanalisation with RT is the treatment of choice for acute thrombosis of healthy native arteries (4–7 mm); the treatment of thrombosis complicating calcified plaques or dissection intimal flaps may cause rupture of the arterial wall. In subacute and chronic occlusions of by-pass grafts, stents and stent grafts, additional procedures are necessary to achieve complete recanalisation.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare l’efficacia della trombectomia rotazionale (TR) mediante sistema Rotarex nel trattamento delle occlusioni trombotiche in arterie native, by-pass, stents e stentsgrafts.

Materiali e metodi

Negli ultimi 4 anni sono stati selezionati 22 pazienti (14 maschi e 8 femmine; età media 62,6 anni) portatori di 5 occlusioni trombotiche acute (< a 14 giorni) in arteria nativa (4 trombosi su placca dell’arteria iliaca comune, 1 trombosi su flap di dissezione dell’arteria iliaca esterna), 17 occlusioni trombotiche subacute e croniche in 4 by-pass femoro-poplitei, 10 stents (7 in arteria iliaca comune e 3 in arteria femorale superficiale) e 3 stents-grafts. Nel caso delle trombosi acute il follow-up è stato effettuato con eco-color doppler dopo 1 e 3 mesi dalla procedura. Nelle trombosi subacute e croniche il follow-up è stato eseguito con eco-color doppler a 1, 3, 6 e 12 mesi e successivamente annualmente.

Risultati

Nelle occlusioni acute in arteria nativa (4/22 casi) è stato ottenuto successo tecnico immediato, senza necessità di ulteriori procedure. Nelle occlusioni sub-acute e croniche è stata associata l’angioplastica (PTA) (8/22 casi), cutting ballon (6/22) e stenting (5/22). Il tasso di complicanze è risultato del 4,8% (1 rottura di arteria iliaca esterna trattata mediante stent-graft).

Conclusioni

La ricanalizzazione mediante TR è il trattamento di scelta nelle occlusioni trombotiche acute su arteria sana (4–7 mm); il trattamento della trombosi su placca calcifica e su flap di dissezione può comportare la rottura della parete arteriosa. Nelle occlusioni sub-acute e croniche di by-pass, stents e stent-grafts la completa ricanalizzazione necessita di procedure aggiuntive.

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Authors and Affiliations

  1. Department of Radiology, University of Insubria, V.le Borri 57, Varese, Italy

    D. Laganà, G. Carrafiello, D. Lumia, F. Fontana, M. Mangini, F. A. Vizzari & C. Fugazzola

  2. Department of Vascular Surgery, University of Insubria, V.le Borri 57, Varese, Italy

    G. Piffaretti

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  1. D. Laganà
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  2. G. Carrafiello
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  3. D. Lumia
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  4. F. Fontana
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  5. M. Mangini
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  6. F. A. Vizzari
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  7. G. Piffaretti
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  8. C. Fugazzola
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Correspondence to D. Laganà.

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Laganà, D., Carrafiello, G., Lumia, D. et al. Recanalisation of thrombotic arterial occlusions with rotational thrombectomy. Radiol med 116, 932–944 (2011). https://doi.org/10.1007/s11547-010-0611-3

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  • DOI: https://doi.org/10.1007/s11547-010-0611-3

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