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First published April 2003

Early Experience with a Rotational Thrombectomy Device for Treatment of Acute and Subacute Infra-Aortic Arterial Occlusions

Thomas Zeller, MD [email protected], Ulrich Frank, MD, Karlheinz Bürgelin, MD, Christian Müller, MD, Peter Flügel, MD, Barbara Horn, MD, Uwe Schwarzwälder, MD, and Franz-Josef Neumann, MDView all authors and affiliations

Volume 10, Issue 2

https://doi.org/10.1177/152660280301000224

Abstract

Purpose:

To evaluate a rotational thrombectomy device in the treatment of acute and subacute/chronic thrombotic infra-aortic occlusions of native vessels and bypass grafts.

Methods:

From July 2000 to February 2002, 98 patients (65 men; mean age 66±9 years, range 47–90) with 100 thrombotic occlusions (mean age of occlusion 31±33 days, range 0–140) measuring an average of 21±11 cm long (range 2–40) were treated with rotational thrombectomy (Rotarex). There were 33 acute (≤14 days) thrombotic/embolic native artery occlusions (group I), 58 subacute/chronic (>14 days) native artery occlusions (group II), and 9 acute bypass graft occlusions (group III).

Results:

The device activation time was 4.9±1.4 minutes, during which 4.0±1.4 passes of the device were performed. The amount of aspirated fluid was 240±119 mL. Slightly less than half the arteries (48%) were stented. Primary success (residual stenosis <30%) was achieved in 92% (94% for group I, 93% for group II, and 78% for group III; 100% for the ipsilateral approach, 56% for the crossover approach). Among the 18 complications, 3 were serious (2 amputations after unsuccessful intervention and 1 death); there were 8 vessel perforations and 7 cases of peripheral embolization. Thirty-day survival and limb salvage was 88% for group I, 100% for group II, and 66% for group III.

Conclusions:

The device is an easy-to-handle, useful tool for ipsilateral treatment of acute and subacute thrombotic arterial and bypass graft occlusions. The use of this device is limited by the 8-F diameter of the catheter and the limited capacity for crossover interventions.

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References

1. Blaisdell FW, Steele M, Allen RE. Management of acute lower extremity arterial ischemia due to embolism and thrombosis. Surgery. 1978; 84: 822–834.

2. Gordon RD, Fogarty TJ. Peripheral arterial embolism. In: Rutherford RB, ed. Vascular Surgery. 2nd ed. Philadelphia: WB Saunders; 1984: 451.

3. Pemberton M, Varty K, Nydahl S, et al. The surgical management of acute limb ischaemia due to native vessel occlusion. Eur J Vasc Endovasc Surg. 1999; 17: 72–76.

4. Palfreyman SJ, Michaels JA. Vascular Surgical Society of Great Britain and Ireland: Systematic review of intra-arterial thrombolytic therapy for peripheral vascular occlusions. Br J Surg. 1999; 86:–704.

5. Ouriel K, Veith FJ, Sasahara AA. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med. 1998; 338: 1105–1111.

6. Weaver FA, Comerota AJ, Youngblood M, et al. Surgical revascularization versus thrombolysis for nonembolic lower extremity native artery occlusions: Results of a prospective randomized trial. The STILE Investigators. Surgery versus Thrombolysis for Ischemia of the Lower Extremity. J Vasc Surg. 1996; 24: 513–523.

7. Lammer J, Pilger E, Neumayer K, et al. Intra-arterial fibrinolysis: Long term results. Radiology. 1986; 161: 159–163.

8. Diffin DC, Kandarpa K. Assessment of peripheral intraarterial thrombolysis versus surgical revascularization in acute lower-limb ischemia: A review of limb-salvage and mortality statistics. J Vasc Interv Radiol. 1996; 7: 57–63.

9. Hess H, Mietaschke A, von Bilderling P, et al. Peripheral arterial occlusion: Local low-dose thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA). Eur J Vasc Endovasc Surg. 1996; 12: 97–104.

10. Tepe G, Luz O, Hahn U, et al. Pulsed spray lysis with reteplase in peripheral arterial occlusionstechnique and initial results [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2000; 172: 780–784.

11. Zähringer M, Heindel W, Gawenda M, et al. Acute thromboembolic occlusion of the A. poplitea and of the trifurcation originating from a persistent primitive A. ischiadica [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1999; 171: 79–81.

12. McNamara TO, Bomberger RA, Merchant RF. Intra-arterial urokinase as the initial therapy for acutely ischemic lower limbs. Circulation. 1991; 83(2 Suppl): I-106–I-119.

13. Meyerovitz MF, Goldhaber SZ, Reagan K, et al. Recombinant tissue-type plasminogen activator versus urokinase in peripheral arterial and graft occlusions: A randomised trial. Radiology. 1990; 175: 75–78.

14. Jung EM, Lutz R, Rupp N. Low-dose thrombolysis using rt-Pa in extensive peripheral vascular occlusion [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2000; 172: 1028–1034.

15. Sharafuddin MJ, Hicks ME. Current status of percutaneous mechanical thrombectomy. General principles. J Vasc Interv Radiol. 1997; 8: 911–921.

16. Soulen MC, Zaetta JM, Amygdalos MA, et al. Mechanical declotting of thrombosed dialysis grafts: Experience in 86 cases. J Vasc Interv Radiol. 1997; 8: 563–567.

17. Bildsoe MC, Moradian GP, Hunter DW, et al. Mechanical clot dissolution: New concept. Radiology. 1989; 171: 231–233.

18. Schmitz-Rode TH, Adam G, Kilbinger M, et al. Fragmentation of pulmonary emboli: In vivo experimental evaluation of two high-speed rotating catheters. Cardiovasc Intervent Radiol. 1996; 19: 165–169.

19. Bucker A, Schmitz-Rode T, Vorwerk D, et al. Comparative in vitro study of two percutaneous hydrodynamic thrombectomy systems. J Vasc Interv Radiol. 1996; 7: 445–449.

20. Reekers JA, Kromhout JG, Van Der Waal K. Catheter for percutaneous thrombectomy: First clinical experience. Radiology. 1993; 188: 871–874.

21. Nazarian GK, Qian ZQ, Coleman CC, et al. Hemolytic effect of the Amplatz thrombectomy device. J Vasc Interv Radiol. 1994; 5: 155–160.

22. Beyer-Enke SA, Deichen J, Zeitler E. The long-term results after Hydrolyser-supported angioplasty-a prospective study [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1999; 171: 126–129.

23. Rousseau H, Sapoval M, Ballini P, et al. Percutaneous recanalization of acutely thrombosed vessels by hydrodynamic thrombectomy (Hydrolyser). Eur Radiol. 1997; 7: 935–941.

24. Henry M, Amor M, Henry I, et al. Thrombectomy with the hydrolysing catheter. Apropos of 50 cases [in French]. Arch Mal Coeur Vaiss. 1997; 90: 797–804.

25. Pitton MB, Neufang A, Düber C. Therapy of thromboembolic blockages in the crural arteries: Clinical experience with the Angiojet thrombectomy catheter [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1999; 171: 380–385.

26. Starck EE, Wagner HJ. Rotation aspiration thromboembolectomy [in German]. Dtsch Med Wochenschr. 1991; 116: 1–6.

27. Höpfner W, Vicol C, Bohndorf K, et al. Percutaneous transluminal hydrodynamic thrombectomy-the initial results [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1996; 164: 141–145.

28. Schmitt HE, Jäger KA, Jacob AL, et al. A new rotational thrombectomy catheter: System design and first clinical experience. Cardiovasc Intervent Radiol. 1999; 22: 504–509.

29. Zeller T, Müller C, Frank U, et al. The Straub-Rotarex thrombectomy system: Initial experiences [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2001; 173: 626–631.

30. Berczi V, Deutschmann HA, Schedlbauer P, et al. Early experience and midterm follow-up results with a new rotational thrombectomy catheter. Cardiovasc Intervent Radiol. 2002; 25: 275–281.

31. Zeller T, Frank U, Bürgelin K, et al. Acute thrombotic subclavian artery occlusion treated with a new rotational thrombectomy device. J Endovasc Ther. 2002; 9: 917–921.

32. Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). Int Angiol. 2000; 19(Suppl 1): 151–154.

33. Rutherford RB, Becker GJ. Standards for evaluating and reporting the results of surgical and percutaneous therapy for peripheral arterial disease. Radiology. 1991; 181: 277–281.

34. Henry M, Amor M, Henry I, et al. The Hydrolyser thrombectomy catheter: A single-center experience. J Endovasc Surg. 1998; 5: 24–31.

35. Van Ommen V, Van der Veen FH, Daemen MJ, et al. In vivo evaluation of the Hydrolyser hydrodynamic thrombectomy catheter. J Vasc Interv Radiol. 1994; 5: 823–826.

36. Vorwerk D, Sohn M, Schurmann K, et al. Hydrodynamic thrombectomy of hemodialysis fistulas: First clinical results. J Vasc Interv Radiol. 1994; 5: 813–821.

37. Overbosch EH, Pattynama PM, Aarts HJ, et al. Occluded hemodialysis shunts: Dutch multicenter experience with the Hydrolyser catheter. Radiology. 1996; 201: 485–488.

38. Reekers JA, Kromhout JG, Spithoven HG, et al. Arterial thrombosis below the inguinal ligament: Percutaneous treatment with a thrombosuction catheter. Radiology. 1996; 198: 49–53.

39. Qian Z, Wholey M, Ferral H, et al. Recanalization of thrombosed superficial femoral arteries with a hydraulic thrombectomy catheter in a canine model. AJR Am J Roentgenol. 1999; 173: 1557–1563.

40. Trerotola SO, Lund GB, Scheel PJ, et al. Thrombosed dialysis access grafts: Percutaneous mechanical declotting without urokinase. Radiology. 1994; 191: 721–726.

41. Yasui K, Qian Z, Nazarian GK, et al. Recirculation-type Amplatz clot macerator: Determination of particle size and distribution. J Vasc Interv Radiol. 1993; 4: 275–278.

42. Tadavarthy SM, Murray PD, Inampudi S, et al. Mechanical thrombectomy with the Amplatz device: Human experience. J Vasc Interv Radiol. 1994; 5: 715–724.

43. Rilinger N, Gorich J, Friedrich JM, et al. Thrombectomy using a high-speed rotatable catheter-initial results [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1996: 164: 153–157.

44. Müller-Hülsbeck S, Link J, Schwarzenberg H, et al. Mechanical thrombolysis with the Amplatz thrombectomy catheter [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1996: 165: 375–379.

45. Uflacker R, Strange C, Vujic I. Massive pulmonary embolism: Preliminary results of treatment with the Amplatz thrombectomy device. J Vasc Interv Radiol. 1996; 7: 519–528.

46. Uflacker R, Rajagopalan PR, Vujic I, et al. Treatment of thrombosed dialysis access grafts: Randomized trial of surgical thrombectomy versus mechanical thrombectomy with the Amplatz device. J Vasc Interv Radiol. 1996; 7: 185–192.

47. Gandini R, Maspes F, Sodani G, et al. Percutaneous ilio-caval thrombectomy with the Amplatz device: Preliminary results. Eur Radiol. 1999; 9: 951–958.

48. Müller-Hülsbeck S, Schwarzenberg H, Tschach T, et al. In vitro comparison of a size 6F and 8F high-speed rotational catheter for mechanical thrombus fragmentation [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1999; 170: 94–98.

49. Müller-Hülsbeck S, Schwarzenberg H, Bangard C, et al. Suction pump-supported aspiration thrombectomy: An in-vitro comparison with a thrombus fragmentation procedure [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1998; 168: 191–194.

50. Müller-Hülsbeck S, Schwarzenberg H, Heller M. Guidewire-controlled advancement of the Amplatz thrombectomy device. Cardiovasc Intervent Radiol. 1998; 21: 84–87.

51. Gu X, Sharafuddin MJ, Titus JL, et al. Acute and delayed outcomes of mechanical thrombectomy with use of the steerable Amplatz thrombectomy device in a model of subacute inferior vena cava thrombosis. J Vasc Interv Radiol. 1997; 8: 947–956.

52. Trerotola SO, Johnson MS, Schauwerker DS, et al. Pulmonary emboli from pulse-spray and mechanical thrombolysis: Evaluation with an animal dialysis-graft model. Radiology. 1996; 200: 169–176.

53. Lajvardi A, Trerotola SO, Strandberg JD, et al. Evaluation of venous injury caused by a percutaneous mechanical thrombolytic device. Cardiovasc Intervent Radiol. 1995; 18: 172–178.

54. Krankenberg H, Gehrt I, Sorge I, et al. Treatment of peripheral arterial thromboembolic occlusions using a new percutaneous mechanical thrombectomy system [in German]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2001; 173: 236–239.

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Published In

Journal of Endovascular Therapy

Volume 10, Issue 2

Pages: 322 - 331

Article first published: April 2003

Issue published: April 2003

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© 2003 SAGE Publications.

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PubMed: 12877617

Authors

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Thomas Zeller, MD

Department of Angiology, Heart-Center Bad Krozingen, Germany

[email protected]

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Ulrich Frank, MD

Department of Angiology, Heart-Center Bad Krozingen, Germany

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Karlheinz Bürgelin, MD

Department of Angiology, Heart-Center Bad Krozingen, Germany

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Christian Müller, MD

Department of Internal Medicine, University Hospital Basel, Switzerland

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Peter Flügel, MD

Department of Angiology, Heart-Center Bad Krozingen, Germany

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Barbara Horn, MD

Department of Angiology, Heart-Center Bad Krozingen, Germany

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Uwe Schwarzwälder, MD

Department of Angiology, Heart-Center Bad Krozingen, Germany

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Franz-Josef Neumann, MD

Department of Angiology, Heart-Center Bad Krozingen, Germany

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Notes

Address for correspondence and reprints: Dr. Thomas Zeller, Abteilung Angiologie am Herz-Zentrum Bad Krozingen, Südring 15, D-79189 Bad Krozingen, Germany. Fax: 49-7633-402-8208; E-mail: [email protected]

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