Percutaneous hydromechanical thrombectomy in acute and subacute lower-limbischemia.

Purpose: A prospective study should evaluate the primary and 2-year results of treating acute and subacute lower-limb ischemia with hydromechanical th rombectomy (HTE). Materials and Methods: Consecutively 64 patients, 12 with viable and 52 with threatening limb ischemia and onset of symptoms within 8 +/- 9 days, were treated and controlled for 24 months. An 8 F hydromechan ical thrombectomy device (HTK), was used. It sucks and shreds the thrombi. The shredded particles are transported to the outside. Results: In 8 patien ts a total, in the others a partial restoration of the vessel lumen up to 7 0-50 % was achieved in a mean time of 34 minutes. Residual thrombi, underly ing atherosclerotic Vessel disease and occluded arteries with a small diame ter made adjunctive interventions (balloon angioplasty, percutaneous aspira tion thrombectomy, lysis) necessary. Clinical symptoms and the ankle-brachi al index improved significantly (p<0.01). Primary patency was 72 %, 70 %, 6 7 %, and 65 %; the limb salvage rates were 81 %, 78 %, 75 %, and 73 % for o ne, 3, 12, and 24 months respectively. Device-induced complications did not occur. Conclusions: The HTK allowed a rapid reduction of fresh thrombotic material without complications. In 78 % of the cases adjunctive therapies a re required for wall-adherent thrombi and when tibial vessels with smaller lumina are included. Longterm results are comparable to literature data for fibrinolytic or operative regimens. The advantage, however of the HTK seem s to be the reduction of intervention time and intra-arterial dosage of fib rinolytic drugs.