[Acute femoro-popliteal ischemia. New therapeutic approach. Respective role of thrombo-aspiration and in situ thrombolysis].

The purpose of this paper is to describe, based on our experience, the respective place of percutaneous thrombo-aspiration and in situ thrombolysis in acute inferior limb ischemia. Between july 1991 and April 1995, 46 patients presenting with acute arterial occlusion were treated by percutaneous thrombo-aspiration related to arterial emboly (n = 24) or acute in situ thrombosis (n = 22). Most of the occlusions lied in the popliteal and distal leg arteries. Complementary balloon angioplasty of the underlying stenosis was performed in 26 cases (53%). Immediat angiographical success was obtained in 96% of the embolic occlusion and 59% of the in situ thrombosis. Based on this experience, we believe that thrombo-aspiration can be performed to treat a recent acute arterial occlusion (10-20 days) of the terminal part of the superficial femoral artery, with extension distaly to the origin of the leg arteries. This technique is easy to perform and can be proposed as a alternative to the Fogarty catheter in acute short emboli occlusion (length than 15 cm long) on normal or pathologic arteries. Extension of this indication for critical ischemia in patients with no possibility of surgical revascularization, can be proposed using combination of in situ fibrinolysis and thrombo-aspiration with percutaneous angioplasty, at the site or on run off.