ABSTRACT
Objective To investigate the application of Rotarex mechanical thrombectomy system in lower extremity arterial thrombosis and to evaluate its clinical efficacy.Methods The clinical data of 61 patients(71 limbs,35 cases in acute phase,21 cases in subacute phase and 5 cases in chronic phase)with lower extremity arterial thrombosis treated with Rotarex were analyzed retro-spectively.Distal protective device was used in patients with poor distal artery outflow.High pressure saline was used during the pro-cedure and stent was used in patients with flow-limiting dissection.Catheter aspiration was performed in patients with distal artery embo-lization.Anticoagulant therapy was used in patients with thromboembolism and dual antiplatelet therapy was used in patients with in-situ thrombosis.Postoperative follow-up was performed with color Doppler ultrasound or computed tomography angiography(CTA)at 1 month,3 months and 6 months.Results Fifty-nine cases were treated with 6F Rotarex catheters and 2 cases were treated with 8F Rotarex catheters.Distal protective device was used in 10 cases,balloon dilation was performed in 49 cases and stent was used in 5 cases.Catheter aspiration was performed in 10 cases.Vessel rupture occurred in 4 cases,among whom 3 cases were successfully treated with the method of balloon compression and 1 case was treated with covered stent.Severe adverse events occurred in 4 cases and perioperative toe amputation was performed in 7 cases.Follow-up time was 3 to 6 months(mean 4.9 months).Lower extremity ischemic event occurred in 1 case at 6th month follow-up and was treated with stent.No other lower extremity ischemic events occurred in the course of follow-up.Conclusion For the treatment of lower extremity arterial thrombosis,Rotarex mechanical thrombectomy sys-tem has the advantages of minimally invasion,rapid and high efficiency.Combined with the therapy of catheter aspiration and stent place-ment,vascular patency can be further maintained and the lower extremity ischemic symptoms can be quickly relieved.
ABSTRACT
Objective By using CT-guided percutaneous inoculation with "external pre-loaded and traced one-step implantation technique" to establish VX2 liver and kidney tumor model in experimental rabbits, and to evaluate the effectiveness and convenience of this technique. Methods By using a disposal 16G thoracic puncture needle (length of 8. 5 cm) and a self-made 18 G puncture probe, inoculation of tumor cells was performed in experimental rabbits. Retrograde filling of gelatin sponge strip, which was infiltrated with 0. 3 mL contrast medium, into the thoracic puncture needle lumen was performed, which was followed by retrograde loading of 1X1X3 mm3 VX2 tissue block, and the pre-assembly in vitro was completed. Under CT guidance, percutaneous puncturing of the target organ of experimental rabbit with pre - assembly probe was conducted, then, the end of the needle was inserted into the probe to push out the tumor tissue and gelatin sponge when it was verified that the needle tip reached the desired target point. After 30 seconds, the needle and probe were pulled out slowly and integrally, and the puncture point was manually pressed for 60 seconds. CT scan was performed to check the location of high-density gelatin sponge. The tumor inoculation time was recorded. Contrast - enhanced CT scan was employed at 2, 3 and 4 weeks after inoculation to validate the modeling results. Results Immediate postoperative CT scan showed that the inoculation site was manifested as nodular high density shadow in the liver or kidney parenchyma. Liver tumor modeling was used in 10 rabbits, and tumor formation was obtained in all 10 rabbits (100％, 10/10), and the mean time used for inoculation was 4. 3 minutes. Kidney tumor modeling was adopted in 10 rabbits, and tumor formation was obtained in 9 rabbits (90％, 9/10), and the mean time used for inoculation was 4. 9 minutes. The inoculated tumor was characterized by a single lesion in all experimental rabbits, the location of the tumor was basically the same as that of the high density gelatin sponge. Check-up contrast-enhanced CT scan showed that the liver implanted tumor had peripheral enhancement, which presented as ring - shaped enhancement on DSA. The kidney implanted tumor was manifested as renal parenchyma staining defect on both contrast - enhanced CT scan and DSA. After 3-4 weeks of inoculation, the implanted tumors grew rapidly. Conclusion For the establishment of rabbit VX2 liver and kidney tumor models, CT - guided percutaneous inoculation with "external pre-loaded and traced one-step implantation technique" is very effective. This technique has several advantages, such as convenient and time-saving, postoperative immediate confirmation of the inoculation site, higher tumor formation rate, solitary tumor formation, etc. (J Intervent Radiol, 2018, 27:252-256)