Fluoroscopy-Assisted Thromboembolectomy

ABSTRACT

PURPOSE: Acute limb ischemia continues to be a challenge with high amputation and mortality rates. Conventional thrombectomy allows rapidly removing thrombi, yet this is a blind procedure and it is prone to damage arteries during the operation. In 1996, operative fluoroscopy and over-the-wire (OTW) catheters were reported to allow safe removal of thrombus in patients with acute limb ischemia. We have recently adopted the procedure and we report on our results. METHODS: During the past one year, we treated 7 patients who had acute or subacute lower limb ischemia. Under general or local anesthesia, the femoral artery was exposed and a sheath was inserted. Under fluoroscopy, a guidewire was passed through the thrombus; then a Fogarty Thru-lumen catheter (TLC) was passed into the lesion and thrombectomy was performed. RESULTS: Four patients were female and three were male. Their ages ranged 55 to 79. The symptom duration was within 10 days for five patients, and 1 and 2 months for two others, respectively. The ischemic severity was class I in two patients, IIa in four and IIb in one. There were two iliac occlusions and five femoral-popliteal occlusions. The occlusion length ranged from 5 to 47 cm. Local anesthesia was done for 6 patients. Removal of thrombus was complete or nearly complete in 6 patients, and this was partial in 1 due to rupture of the posterior tibial artery. Additional balloon angioplasty was performed in one patient. All the symptoms resolved in all but one patient, who had persistent foot ischemia. One patient died 2 months later due to liver failure. CONCLUSION: Fluoroscopy-assisted thrombectomy was quite helpful for safely removing thrombi.