Endovascular methods of treatment for acute thromboses of lower limb arteries

Shipovsky V.N., Dzhurakulov Sh.R., Marov K.B., Poliposyan E.A., Nechaev A.I.
Municipal Clinical Hospital № 57 Paediatric Department, Chair of Surgical Diseases Russian State Medical University,
Moscow, Russia

The article exemplifies that a group of patients presenting with acute thrombosis of lower- limb arteries appears to belong to the severest patient cohort, whose treatment remains a difficult task for a vascular surgeon, since the solution of this problem cannot be limited to thrombectomy alone, and in the overwhelming majority of cases should be completed by removing the cause of thrombogenesis, to put it more precisely, by a reconstructive vascular operation, for instance, thromboendarterectomy (bypass grafting, prosthetic repair reconstruction), or by an endovascular procedure. All this taken into consideration compels the investigators to search for safer, minimally invasive and at the same time efficient methods of treatment. Endovascular methods aimed at restoration of the arterial lumen meet these requirements to a considerable degree.

To endovascular methods of treatment for acute thromboses belong the techniques of aspiration thrombectomy, fibrinolytic thrombolysis, mechanical thrombectomy, rotational, rheolytic thrombectomy, stent-grafting or balloon angioplasty. The policy of fibrinolytic thrombolysis has found rather a wide application in clinical practice. However, the use of this technique is also limited due to a variety of currently existing large disadvantages: a long list of contraindications, labour-consuming and demanding nature of the procedure (requiring to be performed 6-12 hours after the onset of the symptoms of the disease, and check-up angiography within 24-48 hours) as well as rather a high rate of early haemorrhagic complications rate (up to 10-5%). The technique of rotation mechanical thrombectomy has for a long time remained insufficiently claimed for and used more frequently in experimental activity due to the presence of a series of risk factors limiting its application (a high risk of embolism of the distal portion, haemolysis, and a vascular injury). Currently, with the advent of the devices combining rotor fragmentation with simultaneous aspiration of the thrombotic masses (Rotcirex), this method of endovascular treatment is a promising technique requiring further development and widespread use in clinical practice.

KEY WORDS: endovascular operations, methodology of rotational mechanical thrombectomy, fibrinolytic thrombolysis.

P. 66

« Back