Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries

AIM To examine the efficacy and safety of the 6 French(6F) Rotarex~S catheter system in patients with acute limb ischemia(ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.METHODS The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the Rotarex~S catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and followup from these patients were further used for analysis.RESULTS Two patients(29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F Rotarex~S catheter. Additional Rotarex~S catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases(29%), in the tibiofibular tract and posterior tibial artery in two of seven cases(29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases(43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.CONCLUSION Mechanical debulking using the 6F Rotarex~S catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.

Successful recanalization of long femoro-crural occlusive disease after failed bypass surgery

Patients with critical limb ischemia necessitate immediate intervention to restore blood flow to the affected limb.Endovascular procedures are currently preferred for these patients.We describe the case of an 80-year-old female patient who presented to our department with ischemic rest pain and ulceration of the left limb.The patient had history of left femoral popliteal bypass surgery,femoral thromboendarterectomy and patch angioplasty of the same limb 2 years ago.Doppler sonography and magnetic resonance angiography revealed an occlusion of the left superficial femoral artery(SFA) and popliteal artery and of all three infra-popliteal arteries.Due to severe comorbidities,the patient was scheduled for a digital subtraction angiography.An antegrade approach was first attempted,however the occlusion could not be passed.After revision of the angiography acquisition,a stent was identified at the level of the mid SFA,which was subsequently directly punctured,facilitating the retrograde crossing of the occlusion.Thereafter,balloon angioplasty was performed in the SFA,popliteal artery and posterior tibial artery.The result was considered suboptimal,but due to the large amount of contrast agent used,a second angiography was planned in 4 wk.In the second session,drug coated balloons were used to optimize treatment of the SFA,combined with recanalization of the left fibular artery,to optimize outflow.The post-procedural course was uneventful.Ischemic pain resolved completely after the procedure and at 8 wk of follow-up and the foot ulceration completely healed.