Li Wenrui, Xing Yunchao, Feng Hai, Chen Xueming, Zhang Zhiwen
Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Front Surg. 2023 Jan 6;9:1017045. doi: 10.3389/fsurg.2022.1017045. eCollection 2022.
Acute limb embolism (ALE) is a challenging, highly morbid, and frequently fatal vascular emergency. Percutaneous mechanical thrombectomy (PMT) devices are an alternative treatment to restore perfusion by removing emboli in the limb arterial system. We evaluated the outcomes of treatment of ALE patients using PMT devices in our center.
A retrospective review of ALE patients treated with Rotarex S (Straub Medical) at a single institution from 2018 to 2022 was performed. The primary outcome was technical success, defined as complete recanalization of the occluded segment with satisfactory outflow and good capillary filling of the distal parts of the foot without any major or obstructing residual emboli or thrombi either in the treated segment or in the outflow tract without the need for additional catheter-directed thrombolysis (CDT) or conversion to open surgery. Embolized segments treated, treatment outcomes, and perioperative complications were reviewed.
A total of 17 ALE patients (29% men, 71% women; mean age, 73 years) underwent PMT procedures. The femoral arteries and popliteal arteries are the most commonly treated vessels, with both present in 59% of the patients. The technical success rate was 100%, but the majority of cases (82%) had concurrent percutaneous transluminal angioplasty or stent grafting, and two patients were treated with urokinase during the operation. There was one thrombotic recurrence that required amputation. There were no 30-day deaths. Complications included extravasation after PMT (two), intraoperative embolization of the outflow tract (one), access site hematoma (one), target artery thrombosis (one), and acute kidney injury (one). There were no severe bleeding complications.
The Rotarex S device has a satisfactory success rate, although complementary use of various adjunctive techniques is frequently required. It seems to be a moderately effective tool for treating ALE to avoid CDT or open surgery. The device appears safe, with low risks of amputation and mortality rates, but special attention should be given to the potential for extravasation and distal embolism.
急性肢体栓塞（ALE）是一种具有挑战性、高致残性且常致命的血管急症。经皮机械血栓切除术（PMT）设备是通过清除肢体动脉系统中的栓子来恢复灌注的一种替代治疗方法。我们评估了在我们中心使用PMT设备治疗ALE患者的疗效。
对2018年至2022年在单一机构接受Rotarex S（施特劳布医疗公司）治疗的ALE患者进行回顾性研究。主要结局指标为技术成功，定义为闭塞段完全再通，流出道满意，足部远端毛细血管充盈良好，治疗段或流出道无任何主要或阻塞性残留栓子或血栓，无需额外的导管定向溶栓（CDT）或转为开放手术。回顾治疗的栓塞段、治疗结局和围手术期并发症。
共有17例ALE患者（男性29%，女性71%；平均年龄73岁）接受了PMT手术。股动脉和腘动脉是最常治疗的血管，59%的患者两者均有病变。技术成功率为100%，但大多数病例（82%）同时进行了经皮腔内血管成形术或支架植入术，两名患者在手术期间接受了尿激酶治疗。有1例血栓复发需要截肢。无30天内死亡病例。并发症包括PMT后渗漏（2例）、术中流出道栓塞（1例）、穿刺部位血肿（1例）、靶动脉血栓形成（1例）和急性肾损伤（1例）。无严重出血并发症。
Rotarex S设备成功率令人满意，尽管经常需要联合使用各种辅助技术。它似乎是治疗ALE以避免CDT或开放手术的一种中等有效的工具。该设备似乎是安全的，截肢和死亡率风险较低，但应特别注意渗漏和远端栓塞的可能性。
