Our Experience with Percutaneous Treatment of Thromboembolic Occlusions of Peripheral Arteries and Bypasses

Overview

Acute occlusions of peripheral arteries may threaten the patients extremities and life. Surgical treatment-Fogartythromboembolectomy-has several disadvantages. Percutaneous (catheter) therapy particularly of infra-inguinal acute occlusions is a relative new and promising method. Following methods and their combinations were used in this study:1. Local continuous thrombolysis - was performed with an end-hole catheter in an intra-thrombus position. Continuous intraarterial infusion of thrombolysic agent - recombinant tissue-plasminogen aktivátor (rt-PA, Actilyse) in a dose of 1-2 mg/h - was used in this study. Angiography was performed in 12-bour intervals, the infusion lasted several hours or days (12-72 hours) until complete lysis was accomplished.2. Percutaneous aspiration thromboembolectomy (PAT) - aspiration of thrombi and emboli using a thin wall catheter and 50 ccm syringe (with negative pressure) was performed occluding thrombi and emboli were fresh and non-adherent to the arterial wall.3. Percutaneous transluminal angioplasty ofthe underlying stenosis in tase ofthrombosis. PTA was completed by stem implantation if the result of balloon dilatation was suboptimal. Further indication for stem implantation was to prevent distal embolization when thrombi if thrombolysed segment persisted.45 catheter procedures in 44 patients were performed - in 40 cases native arteries were treated, in 5 cases femoropopliteal bypasses were occluded. Thrombolysis only was used in 19 cases (42 %), PAT only in 10 procedures (22 %), the combination of thrombolysis and PAT in 16 cases (36 %) a stem was implantad in 10 cases (22 %).Altogether the percutaneous treatment was successful in 42 cases (93 %). In 3 patients (7 %) the recanalization failed because of rethrombosis during the procedure. In 6 patients (13 %) distal embolization occurred during thrombolysis and mainly after dilatation of residual stenosis. This complication was successfully solved by percutaneous aspiration thromboembolectomy (PAT) during the same session.

Key words:
acute occlusions of peripheral arteries - thrombolysis - aspiration thromboembolectomy.