Cho Sungsin, Joh Jin-Hyun
Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul 05278, South Korea.
Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul 05278, South Korea.
World J Clin Cases. 2025 Aug 16;13(23):105671. doi: 10.12998/wjcc.v13.i23.105671.
Aortoiliac artery stenting has been accepted as the preferred option for the treatment of aortoiliac artery disease because of lower morbidity and mortality compared with bypass surgery. However, acute stent occlusion is a troublesome complication due to the need for open surgery or the risk of distal embolization. Herein, we reported a novel approach to treat the acute thrombotic occlusion of an aortoiliac stent using both hemolytic and conventional mechanical thrombectomy coupled with a large diameter sheath.
A 64-year-old male patient presented with severe claudication of the right leg. The patient's history included multiple prior interventions for aortoiliac lesions. The preoperative computed tomography (CT) imaging showed a thrombotic occlusion of right aortoiliac stenting. An Angiojet Omni thrombectomy catheter (Boston Scientific, Marlborough, MA, United States) was used to remove the thrombus in a retrograde fashion after the successful placement of the large-diameter sheath in the right common femoral artery for prevention of distal embolization. The remnant organized thrombus was removed with an over-the-wire Fogarty catheter (Edwards Lifesciences, Irvine, CA, United States). Completion angiogram and postoperative CT imaging demonstrated complete removal of thrombus and no evidence of distal embolization.
This novel approach provides successful management of acute thrombotic occlusion of aortoiliac stent without distal embolization.
与旁路手术相比，主髂动脉支架置入术因发病率和死亡率较低，已被公认为治疗主髂动脉疾病的首选方法。然而，急性支架闭塞是一个棘手的并发症，因为需要进行开放手术或存在远端栓塞的风险。在此，我们报告了一种新的方法，使用溶血栓和传统机械血栓切除术，并结合大直径鞘管来治疗主髂动脉支架的急性血栓闭塞。
一名64岁男性患者出现严重的右腿间歇性跛行。该患者既往有多次主髂病变的介入治疗史。术前计算机断层扫描（CT）成像显示右主髂动脉支架血栓形成闭塞。在成功将大直径鞘管置入右股总动脉以预防远端栓塞后，使用Angiojet Omni血栓切除术导管（美国波士顿科学公司，马尔伯勒，马萨诸塞州）逆行清除血栓。用金属丝引导的Fogarty导管（美国爱德华生命科学公司，尔湾，加利福尼亚州）清除残余的机化血栓。血管造影完成和术后CT成像显示血栓已完全清除，无远端栓塞迹象。
这种新方法成功地处理了主髂动脉支架的急性血栓闭塞，且无远端栓塞。
