Vorwerk Dierk, Triebe Stefan, Ziegler Steffen, Ruppert Volker
Department of Radiology, Klinikum Ingolstadt, Ingolstadt, Germany.
Department of Vascular Surgery, Klinikum Ingolstadt, Ingolstadt, Germany.
Cardiovasc Intervent Radiol. 2019 Feb;42(2):178-185. doi: 10.1007/s00270-018-2129-3. Epub 2018 Nov 28.
To analyze the immediate outcome of percutaneous mechanical thromboembolectomy in acute infrainguinal leg ischemia in a consecutive cohort of patients with acute lower limb ischemia.
We retrospectively analyzed the data of 156 acute infrainguinal ischemic events in 148 patients. Patients presented with acute limb ischemia Rutherford category I in 68 cases (44%), Rutherford category II A in 64 instances (41%) and Rutherford II B in 24 instances (15%). In 62 cases (39.7%), the occlusion site started below the knee joint level, in 94 (60.3%) cases above. As a basic technique, an intervention was started by manual aspiration but if aspiration failed, an additional device was added. Most frequently, a rotational thrombectomy device (Rotarex, Straub Medical, Wangs, Switzerland) was used. An antegrade access to the femoral artery was the preferred access to the limb (154/156).
In 145 of 156 incidents, a technical success was achieved (93%). Aspiration was used in 153 cases (98%). Rotational thrombectomy by use of the Rotarex catheter was added in 60 cases (38%). Directional atherectomy was applied in a total of five patients. As main technical complications, a downward embolization occurred (n = 11). There were four surgical groin revisions. Five patients died during the early follow-up with four not related to the intervention. Clinically, 135 patients (86.5%) showed an improvement in their clinical situation.
Acute lower limb ischemia can be successfully treated by mechanical thromboembolectomy only by combining aspiration embolectomy with rotational thrombectomy in most cases but manual aspiration alone will frequently fail especially above the knee joint level.
分析在一组连续性急性下肢缺血患者中，经皮机械性血栓切除术治疗急性股腘动脉以下腿部缺血的即时疗效。
我们回顾性分析了148例患者的156次急性股腘动脉以下缺血事件的数据。患者急性肢体缺血Rutherford分级为I级的有68例（44%），II A级的有64例（41%），II B级的有24例（15%）。62例（39.7%）的闭塞部位起始于膝关节水平以下，94例（60.3%）起始于膝关节水平以上。作为基本技术，干预从手动抽吸开始，但如果抽吸失败，则增加额外的器械。最常使用的是旋转血栓切除术器械（Rotarex，瑞士施特劳布医疗公司，旺斯）。顺行进入股动脉是进入肢体的首选途径（154/156）。
156例事件中有145例技术成功（93%）。153例（98%）使用了抽吸。60例（38%）加用了使用Rotarex导管的旋转血栓切除术。共有5例患者接受了定向斑块旋切术。主要技术并发症为向下栓塞（n = 11）。有4例进行了手术腹股沟修复。5例患者在早期随访期间死亡，其中4例与干预无关。临床上，135例患者（86.5%）的临床状况有所改善。
急性下肢缺血在大多数情况下仅通过将抽吸血栓切除术与旋转血栓切除术相结合，机械性血栓切除术可成功治疗，但单独手动抽吸常失败，尤其是在膝关节水平以上。
