PERCUTANEOUS THROMBECTOMY AND MECHANICAL THROMBOLYSIS

Treatment of acute embolic and thrombotic occlusions of arteries has t o be initiated immediately to save the limb at risk. Surgery has been the treatment of choice for the last decades. Percutaneous mechanical methods for thrombectomy and thrombolysis have evolved and offer alter native treatment options, reducing the peri-operative risk, Percutaneo us aspiration thrombembolectomy (PAT), recirculation thrombectomy with the Amplatz device, and different systems for hydrodynamic thrombecto my and thrombolysis (Angiojet, Hydrolyser, S.E.T. catheter) are routin ely used for percutaneous thrombectomy and mechanical thrombolysis. Th ese 3.5-10 F systems allow for the rapid removal of a fresh clot from different vascular regions. Complete removal of the clot can be achiev ed in 19-49%: adjunctive use of other percutaneous methods (thrombolys is and thrombectomy: 60-80%; PTA and atherectomy: 81-100 %) results in primary success rates of 67-100% for recanalization of acutely occlud ed vessels. Primary indications for percutaneous thrombectomy and mech anical thrombolysis are acute occlusions of peripheral arteries and di alysis fistulas; limited experience exists for the treatment of occlus ions of the visceral and pelvic vessels. Percutaneous methods seem pro mising for treatment of acute pulmonary embolism.