Department of Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Lübeck, Germany.
Institute for Diagnostic and Interventional Radiology/Neuroradiology, SANA Hospital, Lübeck, Germany.
Diagn Interv Radiol. 2021 Mar;27(2):249-256. doi: 10.5152/dir.2021.20100.
We aimed to examine lesion characteristics influencing technical outcome and periprocedural peripheral embolization (PPE) during percutaneous mechanical rotational thrombectomy (PMT) of long femoropopliteal artery and bypass occlusions.
Retrospectively, 65 consecutive patients (43 male patients, mean age 70±12 years; Rutherford category I-III), undergoing PMT (Rotarex®, Straub Medical AG) with acutely/subacutely occluded femoropopliteal arteries/bypasses were included. Occlusions (mean length, 217±98 mm) were treated by PMT followed by percutaneous transluminal angioplasty (PTA) plus drug-coated balloon or PTA plus stenting/stentgrafting. Technical success was defined as residual stenosis <30%. Follow-up included duplex ultrasound and ankle-brachial index (ABI) after 12 months. Endpoints were technical success, complications, improvement of Rutherford category, ABI, and patency (re-stenosis <50%). The influence of lesion length, duration, and thrombus density (measured in preinterventional computed tomography angiography) on technical success and PPE was analyzed.
Technical success was 18% (12/65) after PMT alone, 92% (60/65) after additional means. Four patients (6%) underwent bypass surgery and one patient (2%) amputation. PPE occurred in 11% (7/65). During the 12-month follow-up, three patients (5%) were lost to follow-up. ABI increased from baseline 0.5±0.12 to 0.81±0.14 (p = 0.001) and Rutherford category increased by at least one level in 57 patients at 12-month follow-up (clinical success, 88%). At 12 months, primary patency was 57.4% (95% CI, 45.8%-68.9%) and secondary patency was 75.0% (95% CI, 59.8%-72.3%). As risk factors for PPE, we identified lesion length >200 mm (15%; 6/39; OR 4.5; 95% CI, 0.5-40; p = 0.014) and thrombus density ≤45 HU (20%; 2/10; OR 3.0; 95% CI, 0.2-38.9; p = 0.05). No significant relation between risk factors and technical success was found.
PMT followed by PTA or implantation of stent (grafts) appears to be effective and safe for revascularization of acute/subacute long occlusions. Thrombus density <45 HU and lesion length above 20 cm represent risk factors for PPE during PMT.
我们旨在研究影响经皮机械旋转血栓切除术（PMT）治疗长股腘动脉和旁路闭塞时技术效果和围手术期外周栓塞（PPE）的病变特征。
回顾性纳入 65 例连续接受 PMT（Rotarex®，Straub Medical AG）治疗的急性/亚急性股腘动脉/旁路闭塞的患者（43 例男性，平均年龄 70±12 岁；Rutherford 分类 I-III）。闭塞（平均长度 217±98mm）采用 PMT 治疗，随后进行经皮腔内血管成形术（PTA）加药物涂层球囊或 PTA 加支架/支架置入术。技术成功定义为残余狭窄<30%。随访包括 12 个月时的双功超声和踝肱指数（ABI）。终点是技术成功率、并发症、Rutherford 分类、ABI 和通畅率（再狭窄<50%）的改善。分析病变长度、持续时间和血栓密度（在术前 CT 血管造影中测量）对技术成功率和 PPE 的影响。
PMT 单独治疗的技术成功率为 18%（12/65），加用其他方法后的技术成功率为 92%（60/65）。4 例（6%）患者接受旁路手术，1 例（2%）患者接受截肢。11%（7/65）的患者发生 PPE。在 12 个月的随访中，有 3 例（5%）患者失访。ABI 从基线的 0.5±0.12 增加到 0.81±0.14（p=0.001），57 例患者在 12 个月的随访中至少提高了一个 Rutherford 分类水平（临床成功率为 88%）。12 个月时，原发性通畅率为 57.4%（95%CI，45.8%-68.9%），继发性通畅率为 75.0%（95%CI，59.8%-72.3%）。作为 PPE 的危险因素，我们发现病变长度>200mm（15%；6/39；OR 4.5；95%CI，0.5-40；p=0.014）和血栓密度≤45HU（20%；2/10；OR 3.0；95%CI，0.2-38.9；p=0.05）。未发现危险因素与技术成功率之间存在显著关系。
PMT 联合 PTA 或支架（移植物）植入治疗急性/亚急性长段闭塞似乎是有效和安全的。血栓密度<45HU 和病变长度>20cm 是 PMT 期间发生 PPE 的危险因素。
