Safety, Efficacy and Outcome of Rotational Thrombectomy assisted Endovascular Revascularisation of the Superior Mesenteric Artery in Acute Thromboembolic Mesenteric Ischaemia.
Rofo
; 196(10): 1055-1062, 2024 Oct.
Article
en En
| MEDLINE
| ID: mdl-38479411
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. MATERIALS ANDMETHODS:
Fifteen cases of percutaneous rotational thrombectomy- assisted (Rotarex S, BD, USA) revascularization were retrospectively analyzed. The etiology was embolic in 40â% of cases and thrombotic in 60â%. 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.RESULTS:
Device application via femoral access was feasible in 100â% of cases and improved flow in 86.7â% of cases (1â× TIVI 0â1, 11â× TIVI 0â2, 1â× TIVI 1â2). There was no change in 13.3â% of cases (2â× TIVI 2â2). Additional devices resulted in further flow improvement in 93.3â% of cases (8â× TIVI 3, 6â× TIVI 4). One recanalization failed (TIVI 2â2â2). After adjunctive technologies (10â× manual aspiration, 11â× angioplasty, 9â× stenting), the technical success rate was 93.3â%. The mean procedure time was 40.5(±â14) minutes for embolism and 72.1(±â20) minutes for thrombosis. There was one device-related major complication (catheter tip fracture) resulting in a device-related safety rate of 93.3â%. The overall major complication rate was 20â%. Surgical exploration (13â×), bowel resection (9â×) and Fogarty embolectomy/bypass (3â×) were also performed. The 30-day mortality rate was 40â%.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. 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..
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Tromboembolia
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Trombectomía
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Arteria Mesentérica Superior
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Procedimientos Endovasculares
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Isquemia Mesentérica
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Oclusión Vascular Mesentérica
Límite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Rofo
Año:
2024
Tipo del documento:
Article
País de afiliación:
Alemania
Pais de publicación:
Alemania