Malte Maria Sieren1,2, Julian Pfarr3, Schekeb Aludin4, Karim Mostafa4, Erik Stahlberg3,5, Franz Wegner3,5, Sam Mogadas3,5, Rene Rusch6, Marco Horn7, Philipp Schäfer3. 1. Department of Interventional Radiology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany. malte.sieren@uksh.de. 2. Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Lübeck, Germany. malte.sieren@uksh.de. 3. Department of Interventional Radiology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany. 4. Department of Radiology & Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. 5. Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Lübeck, Germany. 6. Department of Vascular Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Lübeck, Germany. 7. Department of Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Abstract
OBJECTIVE: Thrombectomy of the aortoiliac segment remains a challenge for surgical and endovascular revision. This study aimed to evaluate the concept of percutaneous thrombectomy in patients with aortoiliac segment occlusions. MATERIALS & METHODS: Eighteen patients with aortoiliac occlusion who underwent percutaneous thrombectomy were retrospectively identified using the local picture archive and divided into the stent-graft (N = 10) and native vessels (N = 8) groups. The procedure was performed by placing a 12-24 French sheath adjacent to the distal end of the occluded vessel segment. The occlusion was passed with a balloon catheter which was retracted after inflation, to deliver the thrombus into the sheath. Technical success (reperfusion of the vessel and no residual thrombus/stenosis < 30%), complications and primary arterial patency were assessed. Follow-up included computed tomography angiography and evaluation of the clinical situation via telephone. RESULTS: Technical success was achieved in 38% (7/18) of patients after percutaneous thrombectomy alone and in 100% after additional procedures. The most common complication was peripheral embolism (44%, 8/18), which was treated successfully in all cases and was linked to a mismatch between the sheath and target vessel of ≥ 1 mm (P < .01). There were no significant differences in the incidence of complications between the two groups. Primary patency was 72% (13/18) with no significant difference between groups (P = .94). Follow-up CT scans were available for 13/18 patients (72%), with a mean follow-up time of 270 ± 146 days. All patients were contacted via phone (follow-up time, 653 ± 264 days). CONCLUSION: Percutaneous thrombectomy appears to be effective for revascularization of the aortoiliac segment, both in stent-grafts and in native vessels. The most common complication is peripheral embolism; however, the risk may be reduced by choosing an adequate sheath size.
OBJECTIVE: Thrombectomy of the aortoiliac segment remains a challenge for surgical and endovascular revision. This study aimed to evaluate the concept of percutaneous thrombectomy in patients with aortoiliac segment occlusions. MATERIALS & METHODS: Eighteen patients with aortoiliac occlusion who underwent percutaneous thrombectomy were retrospectively identified using the local picture archive and divided into the stent-graft (N = 10) and native vessels (N = 8) groups. The procedure was performed by placing a 12-24 French sheath adjacent to the distal end of the occluded vessel segment. The occlusion was passed with a balloon catheter which was retracted after inflation, to deliver the thrombus into the sheath. Technical success (reperfusion of the vessel and no residual thrombus/stenosis < 30%), complications and primary arterial patency were assessed. Follow-up included computed tomography angiography and evaluation of the clinical situation via telephone. RESULTS: Technical success was achieved in 38% (7/18) of patients after percutaneous thrombectomy alone and in 100% after additional procedures. The most common complication was peripheral embolism (44%, 8/18), which was treated successfully in all cases and was linked to a mismatch between the sheath and target vessel of ≥ 1 mm (P < .01). There were no significant differences in the incidence of complications between the two groups. Primary patency was 72% (13/18) with no significant difference between groups (P = .94). Follow-up CT scans were available for 13/18 patients (72%), with a mean follow-up time of 270 ± 146 days. All patients were contacted via phone (follow-up time, 653 ± 264 days). CONCLUSION: Percutaneous thrombectomy appears to be effective for revascularization of the aortoiliac segment, both in stent-grafts and in native vessels. The most common complication is peripheral embolism; however, the risk may be reduced by choosing an adequate sheath size.
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Authors: S Eichhorn; A Mendoza; A Prinzing; A Stroh; L Xinghai; M Polski; M Heller; H Lahm; E Wolf; R Lange; M Krane Journal: Biomed Res Int Date: 2017-12-17 Impact factor: 3.411