Mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries: immedite results, long-term follow-up

AIM

The aim of this paper was to evaluate the immediate and long-term results of mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries.

METHODS

Patients with acute or subacute occlusions of peripheral arteries were selected consecutively for treatment with the Rotarex system. The average age of our patients was 44-92 years (median [m] 75 years). The duration of symptoms ranged from 1 to 90 days (m 14 days).

RESULTS

Seventy-three interventions in 65 patients were performed. Occlusion length varied from 1 to 37 cm (m 10 cm). Immediate successful recanalization was achieved in 69 interventions (95%). Peripheral embolization represented the most frequent transitory complication (6%). Acute reocclusion following 69 successful interventions occurred in a total of 7 procedures (10%). Cumulative patency rates were 56% after 6 months, 47% after 12 months, 41% after 18 months, 37% after 24 months, 33% after 30 months and 29% after 36 months. The ankle/brachial pressure index prior to intervention ranged from 0 to 0.83 (m 0.53) and increased to 0.42-1.44 (m 0.9) post intervention (P<0.001). Its values after 6, 12, 18, 24, 30 and 36 months were statistically significantly higher than those before procedure. Major amputation was performed in 10% of cases.

CONCLUSIONS

Rotarex thrombectomy represents an effective and safe modality for treating acute and subacute occlusions of peripheral arteries with excellent immediate and satisfactory long-term results. Compared to thrombolysis, the principal advantage of thrombectomy is the rapid recanalization of the given artery.

Mechanical thrombectomy using the Rotarex catheter--safe and effective method in the treatment of peripheral arterial thromboembolic occlusions

BACKGROUND

The aim of the study was to evaluate the efficacy of mechanical thrombectomy using the Rotarex catheter in the treatment of peripheral arterial thromboembolic occlusions and to assess long-term results.

PATIENTS AND METHODS

The Rotarex catheter is a 6F or 8F polyurethane catheter, which contains a steel spiral powered by an electric motor and rotating at a speed of 40.000 rpm. The catheter tip is connected to the spiral. The rotating spiral produces a continuous vacuum and the thromboembolic material "drilled" by the tip is drawn into the catheter, where it is fragmented and transported via the spiral to the collecting bag.

RESULTS

We have conducted 43 interventions in 40 patients (20 men, 20 women), age 44-92 years (mean 76 years). The occlusion length varied from 2-37 cm (mean 8 cm); the duration of symptoms ranged from 2-180 days (mean 14 days), Thrombectomy as the only procedure was sufficient in 11 interventions (25.5%); a combination with PTA was necessary in 21 procedures (49%) and with stent implantation in 11 procedures (25.5%). Angiographic success was achieved in 41 interventions (95%). The most frequent transitory complication was embolization to the calf arteries (9%). Subsequent thrombolysis was administered after 4 procedures (9%). In one case (2%) there was a minor perforation of the peroneal artery. Six-month post-intervention follow-up is available for 34 patients. Patency was preserved in 65% and amputation had to be performed in 12%. After 12 months, 12 patients are followed and 67% of interventions have remained patent.

CONCLUSIONS

The Rotarex system enables fast and efficient treatment of peripheral arterial thromboembolic occlusions. In most cases, this method is capable of replacing thrombolysis.