Clinical efficacy of AngioJet mechanical thrombectomy for the treatment of acute lower extremity arterial embolism and thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

NIU Qibing ,  CHEN Quan , WEN Shiqi , LI Anqiang , DONG Fang , SHI Hao , SUN Wanli

Department of Vascular Surgery, People’s Hospital in Gansu Province, Lanzhou 730000, P. R. China;

Corresponding?author：

CHEN Quan, Email: 13919093907@126.com

Keywords：

acute lower extremity artery embolism; acute lower extremity arter thrombosis; AngioJet mechanical thrombectomy; stent implantation

DOI：

10.7507/1007-9424.201904083

Video：

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Objective This study was aimed to evaluate the clinical efficacy of mechanical thrombectomy using the AngioJet System for the treatment of lower extremity acute arterial embolism and thrombosis.Methods The clinical data of 20 patients with acute lower extremity arterial embolism and thrombosis admitted to the Department of Vascular Surgery in the People’s Hospital in Gansu Province where the author worked from September 2016 to March 2017, were retrospectively analyzed. All patients were treated with the AngioJet mechanical thrombectomy system. Clinical data of the patients were retrospectively collected. The clinical efficacy of AngioJet mechanical thrombectomy wasanalyzed.Results Eighteen (90.0%) of the 20 patients successfully completed the mechanical thrombectomy by using the AngioJet System. The mean time for hospital stay and operation was (4.2±1.4) d and (1.3±0.4) h, respectively. The average doses of urokinase and heparin during operation were (35.80±12.30) ×10⁴ U and (45.10±8.30) mg, respectively. Two patients received a complementary treatment of incision for removing the thrombus. Two patients received catheter-directed thrombolysis after the mechanical thrombectomy, 5 patients received bare-metal stent implantation after balloon expansion. Clinical success was in 16 cases. According to the Cooley standard, 10 patients were in excellent condition,6 in good condition, 2 in fair condition, and 2 in poor condition. There were 2 cases of distal arterial embolization,2 cases of antecardial discomfort of bradycardia, and 4 cases of bleeding at the puncture point, but no serious bleeding complications such as gastrointestinal and intracranial hemorrhage occurred. A total of 16 patients presented myoglobinuria during and after operation. All patients were followed up for 6–12 months. The results of ultrasound examination showed that the artery was patency in 15 cases. One patient died of myocardial infarction in 9 months after surgery,2 patients developed lower extremity ischemia symptoms again after surgery, and 2 patients had lower extremity ulcer caused by lower extremity ischemia symptoms. During the follow-up period, no lower limb necrosis, amputation, and death occurred in the remaining patients.Conclusions The AngioJet mechanical thrombectomy system is safe and effective. Combined with the use of catheter-directed thrombolysis and stent implantation, the AngioJet mechanical thrombectomy could lead to quick recovery of the perfusion of the lower extremity and improve the limb salvage rates, exhibiting excellent clinical value.

Citation： NIU Qibing, CHEN Quan, WEN Shiqi, LI Anqiang, DONG Fang, SHI Hao, SUN Wanli. Clinical efficacy of AngioJet mechanical thrombectomy for the treatment of acute lower extremity arterial embolism and thrombosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 949-953. doi: 10.7507/1007-9424.201904083 Copy

1.	Galanakis N, Kontopodis N, Peteinarakis I, et al. Direct stenting in patients with acute lower limb arterial occlusions: immediate and long-term results. Cardiovasc Intervent Radiol, 2017, 40(2): 192-201.
2.	張雷, 陸清聲, 裴軼飛, 等. AngioJet機械血栓抽吸技術在動脈栓塞及血栓形成中的應用體會. 中國血管外科雜志(電子版), 2016, 8(3): 203-207.
3.	Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2017, 69(11): e71-e126.
4.	張希全, 凌寶存, 朱偉, 等. 介入性腔內機械性血栓碎吸及溶栓術治療周圍動脈急性血栓栓塞. 中國介入影像與治療學, 2009, 6(2): 99-102.
5.	Palfreyman SJ, Booth A, Michaels JA. A systematic review of intra-arterial thrombolytic therapy for lower-limb ischaemia. Eur J Vasc Endovasc Surg, 2000, 19(2): 143-157.
6.	潘升權, 殷世武, 龍海燈, 等. Angiojet血栓清除導管在急性動脈栓塞治療中的應用體會. 安徽醫學, 2018, 39(7): 793-795.
7.	Earnshaw JJ, Whitman B, Foy C. National Audit of Thrombolysis for Acute Leg Ischemia (NATALI): clinical factors associated with early outcome. J Vasc Surg, 2004, 39(5): 1018-1025.
8.	廖傳軍, 楊寶鐘, 張望德, 等. 外科治療非創傷急性下肢缺血154例. 中華外科雜志, 2008, 46(22): 1716-1719.
9.	黃曉鐘, 張紀蔚. 下肢動脈栓塞的置管溶栓治療. 臨床外科雜志, 2013, 21(5): 326-328.
10.	商春雨, 張莉, 張立明. Fogarty球囊導管取栓聯合股動脈置管溶栓治療急性下肢動脈栓塞的療效評價. 中國實用醫藥, 2017, 12(32): 74-75.
11.	張惠林, 殷世武, 項廷淼, 等. Angiojet血栓抽吸系統聯合置管溶栓對急性肢體動脈栓塞性疾病的臨床療效. 實用醫藥雜志, 2017, 34(10): 883-885.
12.	解志磊, 徐敦元, 王文利, 等. AngioJet機械血栓抽吸術在急性下肢缺血中的應用體會. 血管與腔內血管外科雜志, 2017, 3(4): 892-893, 907.
13.	Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: final report of the prospective multicenter PEARL (peripheral use of AngioJet rheolytic thrombectomy with a variety of catheter lengths) Registry. J Vasc Interv Radiol, 2015, 26(6): 777-785.
14.	Dukkipati R, Yang EH, Adler S, et al. Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy. Nat Clin Pract Nephrol, 2009, 5(2): 112-116.
15.	Shen Y, Wang X, Jin SS, et al. Increased risk of acute kidney injury with percutaneous mechanical thrombectomy using AngioJet compared with catheter-directed thrombolysis. J Vasc Surg Venous Lymphat Disord, 2019, 7(1): 29-37.
16.	Weinberg RJ, Okada T, Chen A, et al. Comparison of ASPIRE mechanical thrombectomy versus AngioJet thrombectomy system in a porcine iliac vein thrombosis model. Ann Vasc Surg, 2017, 42(4): 254-262.
17.	Leung DA, Blitz LR, Nelson T, et al. Rheolytic pharmacomechanical thrombectomy for the management of acute limb ischemia: results from the PEARL registry. J Endovasc Ther, 2015, 22(4): 546-557.
18.	王磊, 郭松林, 陰繼凱, 等. AngioJet治療急性髂股靜脈血栓形成的早期療效分析. 中國血管外科雜志(電子版), 2016, 8(4): 303-305, 313.
19.	郭建明, 郭連瑞, 崔世軍, 等. AngioJet血栓抽吸聯合支架成形治療腋靜脈-鎖骨下靜脈血栓形成1例. 介入放射學雜志, 2019, 28(5): 465-467.
20.	孫立巍, 劉艷, 梁增輝. AngioJet血栓抽吸裝置聯合CDT對急性下肢動脈缺血的療效研究. 中國循證心血管醫學雜志, 2019, 11(2): 205-208.
21.	公茂峰, 顧建平, 陳國平, 等. AngioJet血栓清除術在急性下肢動脈缺血治療中的應用. 介入放射學雜志, 2017, 26(6): 509-513.
22.	Escobar GA, Burks D, Abate MR, et al. Risk of acute kidney injury after percutaneous pharmacomechanical thrombectomy using AngioJet in venous and arterial thrombosis. Ann Vasc Surg, 2017, 42: 238-245.
23.	韓新強, 王雪敏, 馬超, 等. AngioJet機械血栓清除術后血紅蛋白尿的原因分析. 中國介入影像與治療學, 2017, 14(4): 218-222.
24.	唐勇, 陳健, 周卿, 等. 不同水化方案預防造影劑腎病臨床研究. 中華實用診斷與治療雜志, 2013, 27(8): 783-785.
25.	卞路, 殷世武, 倪才方, 等. AngioJet血栓清除系統治療急性肢體缺血19例. 介入放射學雜志, 2018, 27(2): 123-127.

1. Galanakis N, Kontopodis N, Peteinarakis I, et al. Direct stenting in patients with acute lower limb arterial occlusions: immediate and long-term results. Cardiovasc Intervent Radiol, 2017, 40(2): 192-201.
2. 張雷, 陸清聲, 裴軼飛, 等. AngioJet機械血栓抽吸技術在動脈栓塞及血栓形成中的應用體會. 中國血管外科雜志(電子版), 2016, 8(3): 203-207.
3. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2017, 69(11): e71-e126.
4. 張希全, 凌寶存, 朱偉, 等. 介入性腔內機械性血栓碎吸及溶栓術治療周圍動脈急性血栓栓塞. 中國介入影像與治療學, 2009, 6(2): 99-102.
5. Palfreyman SJ, Booth A, Michaels JA. A systematic review of intra-arterial thrombolytic therapy for lower-limb ischaemia. Eur J Vasc Endovasc Surg, 2000, 19(2): 143-157.
6. 潘升權, 殷世武, 龍海燈, 等. Angiojet血栓清除導管在急性動脈栓塞治療中的應用體會. 安徽醫學, 2018, 39(7): 793-795.
7. Earnshaw JJ, Whitman B, Foy C. National Audit of Thrombolysis for Acute Leg Ischemia (NATALI): clinical factors associated with early outcome. J Vasc Surg, 2004, 39(5): 1018-1025.
8. 廖傳軍, 楊寶鐘, 張望德, 等. 外科治療非創傷急性下肢缺血154例. 中華外科雜志, 2008, 46(22): 1716-1719.
9. 黃曉鐘, 張紀蔚. 下肢動脈栓塞的置管溶栓治療. 臨床外科雜志, 2013, 21(5): 326-328.
10. 商春雨, 張莉, 張立明. Fogarty球囊導管取栓聯合股動脈置管溶栓治療急性下肢動脈栓塞的療效評價. 中國實用醫藥, 2017, 12(32): 74-75.
11. 張惠林, 殷世武, 項廷淼, 等. Angiojet血栓抽吸系統聯合置管溶栓對急性肢體動脈栓塞性疾病的臨床療效. 實用醫藥雜志, 2017, 34(10): 883-885.
12. 解志磊, 徐敦元, 王文利, 等. AngioJet機械血栓抽吸術在急性下肢缺血中的應用體會. 血管與腔內血管外科雜志, 2017, 3(4): 892-893, 907.
13. Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: final report of the prospective multicenter PEARL (peripheral use of AngioJet rheolytic thrombectomy with a variety of catheter lengths) Registry. J Vasc Interv Radiol, 2015, 26(6): 777-785.
14. Dukkipati R, Yang EH, Adler S, et al. Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy. Nat Clin Pract Nephrol, 2009, 5(2): 112-116.
15. Shen Y, Wang X, Jin SS, et al. Increased risk of acute kidney injury with percutaneous mechanical thrombectomy using AngioJet compared with catheter-directed thrombolysis. J Vasc Surg Venous Lymphat Disord, 2019, 7(1): 29-37.
16. Weinberg RJ, Okada T, Chen A, et al. Comparison of ASPIRE mechanical thrombectomy versus AngioJet thrombectomy system in a porcine iliac vein thrombosis model. Ann Vasc Surg, 2017, 42(4): 254-262.
17. Leung DA, Blitz LR, Nelson T, et al. Rheolytic pharmacomechanical thrombectomy for the management of acute limb ischemia: results from the PEARL registry. J Endovasc Ther, 2015, 22(4): 546-557.
18. 王磊, 郭松林, 陰繼凱, 等. AngioJet治療急性髂股靜脈血栓形成的早期療效分析. 中國血管外科雜志(電子版), 2016, 8(4): 303-305, 313.
19. 郭建明, 郭連瑞, 崔世軍, 等. AngioJet血栓抽吸聯合支架成形治療腋靜脈-鎖骨下靜脈血栓形成1例. 介入放射學雜志, 2019, 28(5): 465-467.
20. 孫立巍, 劉艷, 梁增輝. AngioJet血栓抽吸裝置聯合CDT對急性下肢動脈缺血的療效研究. 中國循證心血管醫學雜志, 2019, 11(2): 205-208.
21. 公茂峰, 顧建平, 陳國平, 等. AngioJet血栓清除術在急性下肢動脈缺血治療中的應用. 介入放射學雜志, 2017, 26(6): 509-513.
22. Escobar GA, Burks D, Abate MR, et al. Risk of acute kidney injury after percutaneous pharmacomechanical thrombectomy using AngioJet in venous and arterial thrombosis. Ann Vasc Surg, 2017, 42: 238-245.
23. 韓新強, 王雪敏, 馬超, 等. AngioJet機械血栓清除術后血紅蛋白尿的原因分析. 中國介入影像與治療學, 2017, 14(4): 218-222.
24. 唐勇, 陳健, 周卿, 等. 不同水化方案預防造影劑腎病臨床研究. 中華實用診斷與治療雜志, 2013, 27(8): 783-785.
25. 卞路, 殷世武, 倪才方, 等. AngioJet血栓清除系統治療急性肢體缺血19例. 介入放射學雜志, 2018, 27(2): 123-127.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical efficacy of AngioJet mechanical thrombectomy for the treatment of acute lower extremity arterial embolism and thrombosis

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