Recanalization of Acute and Subacute Femoropopliteal Artery Occlusions with the Rotarex Catheter: One Year Follow-up, Single Center Experience |
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Authors: | Sylvain R Duc Eric Schoch Markus Pfyffer Regula Jenelten Christoph L Zollikofer |
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Institution: | (1) Department of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland;(2) Department of Internal Medicine, Section of Angiology, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland;(3) Department of Radiology, Balgrist University Hospital, Forchstrasse 340, Zurich, 8008, Switzerland |
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Abstract: | Purpose: To assess the efficacy and safety of a new rotational catheter for percutaneous removal of fresh and organized thrombi in
the femoropopliteal artery.
Methods: Forty-one limbs in 38 patients (age 56–90 years, mean 75.6 years) with acute, subacute or chronic femoropopliteal occlusions
of 1–180 days’ duration (mean 31.6 days) were treated with the Rotarex device. The Fontaine stage was mainly IIB (Rutherford
2–3, 22 patients) or III (Rutherford 4, 14 patients). The length of occlusion varied from 2 to 35 cm (mean 13.1 cm). After
recanalization percutaneous transluminal angioplasty (PTA) was performed if there was a residual stenosis of >25%. Patients
were followed up with color Doppler ultrasound at 48 hr and clinically with Doppler pressures and oscillometry at 3, 6, and
12 months.
Results: After an average of two passages with the Rotarex catheter all but two limbs required PTA for residual stenosis >25%. Five
patients needed additional stenting. Major complications were one groin hematoma requiring blood transfusion and one arteriovenous
fistula spontaneously thrombosing after unsuccessful primary prolonged balloon dilation. Distal embolizations occurred in
10 patients; 6 clinically relevant emboli were aspirated. All occlusions were technically successfully recanalised there were
2 early reocclusions after 1 day and two at 2 weeks. Brachial–ankle indices improved from an average of 0.41 before to 0.93
after recanalization. Primary and secondary patency rates were 62% / 84% after 6 months and 39% / 68% after 1 year. The amputation-free
survival at 12 months was 100%.
Conclusion: The Rotarex mechanical thrombectomy device is an efficient, quick, easy to handle, and safe tool for the treatment of acute,
subacute or even chronic peripheral arterial thromboembolic occlusions. It can be used for short or long occlusions with equal
success, provided the obstruction is not heavily calcified and has been safely passed with a guidewire first. |
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Keywords: | Arteries Femoral arteries Thrombosis thrombectomy |
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