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Safety, Efficacy and Outcome of Rotational Thrombectomy assisted Endovascular Revascularisation of the Superior Mesenteric Artery in Acute Thromboembolic Mesenteric Ischaemia.
- Source :
-
RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin [Rofo] 2024 Oct; Vol. 196 (10), pp. 1055-1062. Date of Electronic Publication: 2024 Mar 13. - Publication Year :
- 2024
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Abstract
- Purpose: To evaluate the efficacy and safety of percutaneous rotational thrombectomy-assisted endovascular revascularization of acute thromboembolic superior mesenteric artery occlusions in acute mesenteric ischemia.<br />Materials and Methods: Fifteen cases of percutaneous rotational thrombectomy- assisted (Rotarex S, BD, USA) revascularization were retrospectively analyzed. The etiology was embolic in 40 % of cases and thrombotic in 60 %. A "Thrombectomy in Visceral Ischemia" (TIVI) 5-point score determined vessel patency at presentation, after percutaneous rotational thrombectomy, and after adjunctive technologies. TIVI 3 indicated nearly complete revascularization (minimal residual side branch thrombus). TIVI 4 indicated complete revascularization. Technical success was defined as successful device application and a final TIVI score of 3/4 after adjunctive technologies. Safety and outcome were also analyzed.<br />Results: Device application via femoral access was feasible in 100 % of cases and improved flow in 86.7 % of cases (1 × TIVI 0→1, 11 × TIVI 0→2, 1 × TIVI 1→2). There was no change in 13.3 % of cases (2 × TIVI 2→2). Additional devices resulted in further flow improvement in 93.3 % of cases (8 × TIVI 3, 6 × TIVI 4). One recanalization failed (TIVI 2→2→2). After adjunctive technologies (10 × manual aspiration, 11 × angioplasty, 9 × stenting), the technical success rate was 93.3 %. The mean procedure time was 40.5(± 14) minutes for embolism and 72.1(± 20) minutes for thrombosis. There was one device-related major complication (catheter tip fracture) resulting in a device-related safety rate of 93.3 %. The overall major complication rate was 20 %. Surgical exploration (13 ×), bowel resection (9 ×) and Fogarty embolectomy/bypass (3 ×) were also performed. The 30-day mortality rate was 40 %.<br />Conclusion: Percutaneous rotational thrombectomy is an effective adjunct for rapid endovascular recanalization of acute thromboembolic superior mesenteric artery occlusions with an acceptable rate of major procedural complications.<br />Key Points: · Percutaneous rotational thrombectomy-assisted superior mesenteric artery revascularization in acute occlusive mesenteric ischemia is feasible and effective.. · Percutaneous rotational thrombectomy facilitates rapid flow restoration in native and stented superior mesenteric artery segments.. · Brachial access should be considered in the case of steep take-off angles of the superior mesenteric artery..<br />Competing Interests: The authors declare that they have no conflict of interest.<br /> (Thieme. All rights reserved.)
- Subjects :
- Humans
Male
Female
Aged
Middle Aged
Retrospective Studies
Aged, 80 and over
Treatment Outcome
Acute Disease
Thrombectomy methods
Thrombectomy instrumentation
Thromboembolism diagnostic imaging
Thromboembolism surgery
Mesenteric Ischemia surgery
Mesenteric Ischemia diagnostic imaging
Mesenteric Artery, Superior diagnostic imaging
Mesenteric Artery, Superior surgery
Endovascular Procedures methods
Mesenteric Vascular Occlusion diagnostic imaging
Mesenteric Vascular Occlusion surgery
Mesenteric Vascular Occlusion therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1438-9010
- Volume :
- 196
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin
- Publication Type :
- Academic Journal
- Accession number :
- 38479411
- Full Text :
- https://doi.org/10.1055/a-2234-0333