Mert DUMANTEPE, Osman FAZLIOĞULLARI, Süha KÜÇÜKAKSU, Mustafa SEREN

Percutaneous mechanical thrombectomy with retrograde popliteal approach for the treatment of acute femoropopliteal stent occlusion

Akut ve subakut femoropopliteal stent tıkanıklığındaakut veya subakut bacak iskemisi, iskeminin derecesinebağlı olarak, ekstremitenin sağkalımını tehlikeye sokandramatik hastalıklardır. Elli altı yaşında erkek hasta,sol bacağındaki kritik iskemi nedeniyle endovaskülerişlemden 10 ay sonra, özellikle alt ekstremite arterlerindeyaygın ateroskleroz ile kliniğimize başvurdu.Anjiyografide daha önce implante edilen stentler ilebirlikte, yüzeyel femoral arterde uzunluğu boyuncatıkanıklık tespit edildi. Retrograd popliteal yaklaşımıtakiben stent içine stent yerleştirme işlemi ile Rotarexsistemi kullanılarak perkütan mekanik trombektomiyapılma kararı alındı. İşlemden sonra 24. saat ve altıncıayda yapılan takip anjiyografisi ve Doppler ultrasondayeterli kan akışı ile damarın açık olduğu saptandı.Akut femoropopliteal stent tıkanıklığının tedavisinderetrograd popliteal yaklaşım ile birlikte perkütanmekanik trombektomi, özellikle cerrahi tedavininyüksek düzeyde riskli olduğu hastalarda değerli birseçenektir.

Akut femoropopliteal stent tıkanıklığı tedavisinde retrograd popliteal yaklaşım ile perkütan mekanik trombektomi

Acute and subacute ischemia of the legs in acute andsubacute femoropopliteal stent occlusion are dramaticconditions which endanger the survival of the limbsdepending on the severity of the ischemia. A 56-year-oldmale patient with generalized atherosclerosis, particularlyextensive in lower limb arteries, was admitted to ourclinic 10 months after endovascular procedure for criticalischemia of the left lower limb. Angiography revealedan occlusion of the superficial femoral artery along itsentire length, including previously implanted stents. Adecision was made to perform percutaneous mechanicalthrombectomy using the Rotarex system with retrogradepopliteal approach followed by a stent-in-stent placementprocedure. Follow-up angiography and Doppler ultrasoundscan at 24 hours after the procedure and at sixth monthsrevealed a patent vessel with satisfactory blood flow.Percutaneous mechanical thrombectomy with retrogradepopliteal approach is an invaluable option for the treatmentof acute femoropopliteal stent occlusion in high-riskpatients, in particular, for surgical treatment.

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1. JH, Laird JR. Overview of new technologies for lower extremity revascularization. Circulation 2007;116:2072-85.
2. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000;31:1-296.
3. Dys K, Drelichowska-Durawa J, Dołega-Kozierowski B, Lis M, Sokratous K, Iwanowski W, et al. Mechanical thrombectomy using Rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture - a case report and literature review. Pol J Radiol 2013;78:74-9.
4. Wissgott C, Kamusella P, Andresen R. Recanalization of acute and subacute venous and synthetic bypass-graft occlusions with a mechanical rotational catheter. Cardiovasc Intervent Radiol 2013;36:936-42.
5. Schmidt A, Bausback Y, Piorkowski M, Werner M, Bräunlich S, Ulrich M, et al. Retrograde recanalization technique for use after failed antegrade angioplasty in chronic femoral artery occlusions. J Endovasc Ther 2012;19:23-9.
6. Dumantepe M, Seren M, Fazlıogullari O, Ayoglu U, Teymen B. Treatment of complex atherosclerotic femoropopliteal artery disease with a self-expanding interwoven nitinol stent: Midterm results. Vascular. 2015 Feb 16. pii: 1708538114568884.