Uflacker R
Department of Radiology, Medical University of South Carolina, Charleston 29425, USA.
J Vasc Interv Radiol. 1997 Nov-Dec;8(6):923-32. doi: 10.1016/s1051-0443(97)70688-2.
To perform a feasibility study of the Amplatz Thrombectomy Device (ATD) in a variety of vascular territories with acute or subacute thrombosis.
Thirteen patients (mean age, 44.6 years) with multiple risk factors who had acute/subacute thrombosis of the inferior vena cava (IVC) and iliac veins (n = 3), superior vena cava (SVC) and/or subclavian veins (n = 3), lower extremity polytetrafluoroethylene (PTFE) graft (n = 2), iliac artery (n = 2), portal vein and transjugular intrahepatic portosystemic shunt (TIPS) (n = 2), and an IVC to pulmonary artery Fontan conduit (n = 1), were treated by means of mechanical thrombectomy with use of the ATD. Thrombolysis failed to recanalize the vessels when used before thrombectomy for 12-34 hours in three patients, and was contraindicated in three other patients. Thrombolysis was used as a complement to the ATD procedure in five patients.
Technical success was achieved in 11 patients, and procedure success was achieved in 10 patients. Failure was observed in the remaining three patients. One patient with a PTFE graft was successfully declotted but thrombosis occurred 2 weeks later, requiring surgery. The other patient with a PTFE graft did not improve and needed surgery to declot and treat the distal anastomosis and distal circulation. The two patients with an occluded iliac artery underwent successful declotting but rethrombosis occurred in one shortly after the procedure requiring thrombolytic therapy. One patient with TIPS thrombosis improved and another patient with a thrombosed portal vein did not improve after thrombectomy.
The ATD is useful for recanalization of acute/subacute clotted native vessels and grafts. The application of the device is broad, and although declotting can be achieved in most cases, long-term success may be limited by anatomical and technical problems of the grafts and multifactorial clinical problems of severely sick patients, as was the case in the series. The use of additional thrombolytic therapy may be necessary in a number of patients.
对Amplatz血栓切除术装置（ATD）在各种伴有急性或亚急性血栓形成的血管区域进行可行性研究。
13例（平均年龄44.6岁）有多种危险因素且患有下腔静脉（IVC）和髂静脉急性/亚急性血栓形成（n = 3）、上腔静脉（SVC）和/或锁骨下静脉急性/亚急性血栓形成（n = 3）、下肢聚四氟乙烯（PTFE）移植物急性/亚急性血栓形成（n = 2）、髂动脉急性/亚急性血栓形成（n = 2）、门静脉和经颈静脉肝内门体分流术（TIPS）急性/亚急性血栓形成（n = 2）以及IVC至肺动脉Fontan导管急性/亚急性血栓形成（n = 1）的患者，采用ATD进行机械性血栓切除术治疗。3例患者在血栓切除术前行溶栓治疗12 - 34小时未能使血管再通，另外3例患者溶栓治疗为禁忌。5例患者将溶栓作为ATD手术的补充治疗。
11例患者获得技术成功，10例患者获得手术成功。其余3例患者手术失败。1例PTFE移植物患者成功清除血栓，但2周后血栓复发，需行手术治疗。另1例PTFE移植物患者病情未改善，需手术清除血栓并处理远端吻合口及远端循环。2例髂动脉闭塞患者成功清除血栓，但其中1例术后不久再次发生血栓形成，需行溶栓治疗。1例TIPS血栓形成患者血栓清除术后病情改善，另1例门静脉血栓形成患者血栓清除术后病情未改善。
ATD对急性/亚急性血栓形成的自体血管和移植物再通有效。该装置应用广泛，虽然多数情况下能清除血栓，但长期成功率可能受移植物的解剖和技术问题以及重症患者多因素临床问题的限制，本系列研究即是如此。许多患者可能需要联合使用溶栓治疗。
