[Percutaneous thrombectomy and mechanical thrombolysis].

Treatment of acute embolic and thrombotic occlusions of arteries has to be initiated immediately to save the limb at risk. Surgery has been the treatment of choice for the last decades. Percutaneous mechanical methods for thrombectomy and thrombolysis have evolved and offer alternative treatment options, reducing the peri-operative risk. Percutaneous aspiration thrombembolectomy (PAT), recirculation thrombectomy with the Amplatz device, and different systems for hydrodynamic thrombectomy and thrombolysis (Angiojet, Hydrolyer, S.E.T. catheter) are routinely used for percutaneous thrombectomy and mechanical thrombolysis. These 3.5-10 F systems allow for the rapid removal of a fresh clot from different vascular regions. Complete removal of the clot can be achieved in 19-49%; adjunctive use of other percutaneous methods (thrombolysis and thrombectomy: 60-80%; PTA and atherectomy: 81-100%) results in primary success rates of 67-100% for recanalization of acutely occluded vessels. Primary indications for percutaneous thrombectomy and mechanical thrombolysis are acute occlusions of peripheral arteries and dialysis fistulas; limited experience exists for the treatment of occlusions of the visceral and pelvic vessels. Percutaneous methods seem promising for treatment of acute pulmonary embolism.