Technique of thrombus aspiration in peripheral intervensions

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Introduction : 

Introduction Distal Embolization is one of the most dreadful endovascular complications Catheter based approach to treat acute artereial occlusion is becoming and increasingly important modality New Devices and techniques are being developed in these situations

Case presentation : 

Case presentation

Case Presentation : 

Case Presentation

Local thrombolysis : 

Local thrombolysis Indicated intra-arterial in occlusion up to 12 weeks below inguinal ligament. Can be done by ipsilateral and contralateral approach Pulse spray rTPA is the best combination Can be used for embolus and thrombosis There is a large list of absolute and relative contrainidication

Local thrombolysis : 

Local thrombolysis Some advocate contraindication above inguinal ligament due to danger of distal embolization Arterial thrombolysis via systemic route is history Some use endhole catheter as Shneider Other used microporous balloons

Which agent and which technique : 

Which agent and which technique

Choice and doage of thrombolysis : 

Choice and doage of thrombolysis Scheme of McNamara begins with high dose an tapered dose is the commonest Urokinase 250000 /h.for 2 hours till lysis then 125000 /h. till complete lysis (from TOPAS trial) rTPA from 0.5mg/h to 10mg/h In STILE trial no difference between urokinase and rTPA results

Slide 9: 

There are two basic tehcniques of thrombolysis either direct thrombus infiltration or perfusion method Direct thrombus infiltration is is faster and less thrombolytic agent and less complications

Catheter Thrombus aspiration : 

Catheter Thrombus aspiration Can be the sole treatment in case of embolus You can probe embolus by GW to test consistency and aspiration to test its mobility There is nearly no contraindication Used more than thrombolysis

Technique of Catheter thrombus aspiration: : 

Technique of Catheter thrombus aspiration:

Technique of Catheter thrombus aspiration: : 

Technique of Catheter thrombus aspiration: The haemostatic valves must be detachable as in sheaths Cordis,Argon,Maxim,Medical Wie aspiration catheter 5F, 8F , Cook,Bard Put the tip on the thrombus Suction with at least 50 Ml Syringe Catheter pulled upstream with suction maintained Slow movement and repeat it

Results of 112 cases in one centre : 

Results of 112 cases in one centre

Practical advise : 

Practical advise Based on our experience we recommend the direct therapeutic catheter approach to acute and subacute thrombo-embolic occlusions of the leg arteries or bypass grafts by combining thrombus aspiration, low-dose thrombus infiltration thrombolysis, and PTA if necessary. A more than 90% success rate may be achieved by this triple approach with minimal complications and good long-term results.

Mechanical thrombectomy devices : 

Mechanical thrombectomy devices Amplatz thrombectomy caheter (Micronova) Arrow treotola thrombolysis system(Arrow) Rheolytic catheter Hydrolyser (Cordis) Angionet (Possis medical) Oasis (Boston) Straub rotarex ( Straub medical)

The Straub-Rotatrex : 

The Straub-Rotatrex

Slide 17: 

Thank you

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