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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2001 March;20(1):66-73

lingua: Inglese

Long-term results of percutaneous thrombo-embolectomy in patients with infrainguinal embolic occlusions

Canova C. R., Schneider E., Fischer L., Leu A. J., Hoffmann U.

From the Depart­ment of Inter­nal Med­i­cine, Divi­sion of Angi­ol­o­gy, Uni­ver­sity Hos­pi­tal ­Zurich, Swit­zer­land


Back­ground. The aim of the study was to ­review early and long term clin­i­cal ­results of per­cut­ane­ous throm­bo-em­bo­lec­to­my in ­patients with acute embol­ic occlu­sions of the infra­in­gui­nal arter­ies.
Meth­ods. Ret­ro­spec­tive anal­y­sis of con­sec­u­tive cases. A total of 88 pro­ce­dures in 84 ­patients were per­fomed ­between 1986 and 1996 in a Uni­ver­sity Hos­pi­tal (46 men, 42 women; mean age 67.6±14.4 years). ­Patients with a his­to­ry of chron­ic symp­to­mat­ic arte­ri­al occlu­sive dis­ease were not includ­ed in the anal­y­sis. Indi­ca­tions for treat­ment were ­severe claud­i­ca­tion (n=45 pro­ce­dures) and limb threat­en­ing ischae­mia (n=43 pro­ce­dures). Per­cut­ane­ous throm­bo-em­bo­lec­to­my was per­formed via an ipsi­lat­er­al ­approach by means of an end­hole aspi­ra­tion cath­e­ter. Local throm­bol­y­sis or bal­loon angio­plas­ty was used as appro­pri­ate dur­ing the inter­ven­tion. Fol­low-up includ­ed clin­i­cal data, ankle pres­sure meas­ure­ments, pulse vol­ume record­ings and ­duplex sonog­ra­phy or angio­gra­phy if indi­cat­ed.
­Results. Tech­ni­cal suc­cess was ­achieved in 85 (96.6%) of the 88 pro­ce­dures. Two ­patients (2.3%) suf­fered major and two ­patients (2.3%) minor com­pli­ca­tions. One ­patient died with­in 30 days after the pro­ce­dure. Mean fol­low-up was 3.7±2.9 years. ­Twelve ­patients (16%) were lost to fol­low-up. Pri­mary clin­i­cal suc­cess rate was 88.4% at one and 81.7% at two years and ­declined to 76.5% at eight years. Out of the 16 inter­val fail­ures 10 (63%) were due to recur­rent embo­lism to the same leg. They result­ed in nine cath­e­ter reinter­ven­tions and one ­bypass graft. Six ­patients were treat­ed con­ser­va­tive­ly. Cumu­la­tive mor­tal­ity was 11.7% at one year and ­increased to 29.5% at eight years.
Con­clu­sions. From our sin­gle cen­tre expe­ri­ence we con­clude that cath­e­ter treat­ment of acute embol­ic occlu­sion of infra­in­gui­nal arter­ies is safe and has favour­able long-term ­results. We there­fore ­regard the tech­nique as a less inva­sive alter­na­tive to sur­gery.

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