Percutaneous Thrombectomy in Patients with Occlusions of the Aortoiliac Segment: A Case Series

Malte Maria Sieren; Julian Pfarr; Schekeb Aludin; Karim Mostafa; Erik Stahlberg; Franz Wegner; Sam Mogadas; Rene Rusch; Marco Horn; Philipp Schäfer

doi:10.1007/s00270-022-03222-y

Percutaneous Thrombectomy in Patients with Occlusions of the Aortoiliac Segment: A Case Series

Cardiovasc Intervent Radiol. 2022 Nov;45(11):1684-1692. doi: 10.1007/s00270-022-03222-y. Epub 2022 Aug 24.

Authors

Malte Maria Sieren^{1

2}, Julian Pfarr³, Schekeb Aludin⁴, Karim Mostafa⁴, Erik Stahlberg^{3

5}, Franz Wegner^{3

5}, Sam Mogadas^{3

5}, Rene Rusch⁶, Marco Horn⁷, Philipp Schäfer³

Affiliations

¹ Department of Interventional Radiology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany. malte.sieren@uksh.de.
² Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Lübeck, Germany. malte.sieren@uksh.de.
³ Department of Interventional Radiology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
⁴ Department of Radiology & Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
⁵ Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Lübeck, Germany.
⁶ Department of Vascular Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Lübeck, Germany.
⁷ Department of Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.

Abstract

Objective: Thrombectomy of the aortoiliac segment remains a challenge for surgical and endovascular revision. This study aimed to evaluate the concept of percutaneous thrombectomy in patients with aortoiliac segment occlusions.

Materials & methods: Eighteen patients with aortoiliac occlusion who underwent percutaneous thrombectomy were retrospectively identified using the local picture archive and divided into the stent-graft (N = 10) and native vessels (N = 8) groups. The procedure was performed by placing a 12-24 French sheath adjacent to the distal end of the occluded vessel segment. The occlusion was passed with a balloon catheter which was retracted after inflation, to deliver the thrombus into the sheath. Technical success (reperfusion of the vessel and no residual thrombus/stenosis < 30%), complications and primary arterial patency were assessed. Follow-up included computed tomography angiography and evaluation of the clinical situation via telephone.

Results: Technical success was achieved in 38% (7/18) of patients after percutaneous thrombectomy alone and in 100% after additional procedures. The most common complication was peripheral embolism (44%, 8/18), which was treated successfully in all cases and was linked to a mismatch between the sheath and target vessel of ≥ 1 mm (P < .01). There were no significant differences in the incidence of complications between the two groups. Primary patency was 72% (13/18) with no significant difference between groups (P = .94). Follow-up CT scans were available for 13/18 patients (72%), with a mean follow-up time of 270 ± 146 days. All patients were contacted via phone (follow-up time, 653 ± 264 days).

Conclusion: Percutaneous thrombectomy appears to be effective for revascularization of the aortoiliac segment, both in stent-grafts and in native vessels. The most common complication is peripheral embolism; however, the risk may be reduced by choosing an adequate sheath size.

Keywords: Aortic occlusion; Endovascular procedures; Iliac occlusion; Percutaneous thrombectomy.

MeSH terms

Embolism*
Humans
Retrospective Studies
Stents
Thrombectomy / methods
Thrombosis*
Treatment Outcome