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.	张雷, 陆清声, 裴轶飞, 等. AngioJet机械血栓抽吸技术在动脉栓塞及血栓形成中的应用体会. 中国血管外科杂志(电子版), 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.	张希全, 凌宝存, 朱伟, 等. 介入性腔内机械性血栓碎吸及溶栓术治疗周围动脉急性血栓栓塞. 中国介入影像与治疗学, 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.	潘升权, 殷世武, 龙海灯, 等. Angiojet血栓清除导管在急性动脉栓塞治疗中的应用体会. 安徽医学, 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.	廖传军, 杨宝钟, 张望德, 等. 外科治疗非创伤急性下肢缺血154例. 中华外科杂志, 2008, 46(22): 1716-1719.
9.	黄晓钟, 张纪蔚. 下肢动脉栓塞的置管溶栓治疗. 临床外科杂志, 2013, 21(5): 326-328.
10.	商春雨, 张莉, 张立明. Fogarty球囊导管取栓联合股动脉置管溶栓治疗急性下肢动脉栓塞的疗效评价. 中国实用医药, 2017, 12(32): 74-75.
11.	张惠林, 殷世武, 项廷淼, 等. Angiojet血栓抽吸系统联合置管溶栓对急性肢体动脉栓塞性疾病的临床疗效. 实用医药杂志, 2017, 34(10): 883-885.
12.	解志磊, 徐敦元, 王文利, 等. AngioJet机械血栓抽吸术在急性下肢缺血中的应用体会. 血管与腔内血管外科杂志, 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, 阴继凯, 等. AngioJet治疗急性髂股静脉血栓形成的早期疗效分析. 中国血管外科杂志(电子版), 2016, 8(4): 303-305, 313.
19.	郭建明, 郭连瑞, 崔世军, 等. AngioJet血栓抽吸联合支架成形治疗腋静脉-锁骨下静脉血栓形成1例. 介入放射学杂志, 2019, 28(5): 465-467.
20.	孙立巍, 刘艳, 梁增辉. AngioJet血栓抽吸装置联合CDT对急性下肢动脉缺血的疗效研究. 中国循证心血管医学杂志, 2019, 11(2): 205-208.
21.	公茂峰, 顾建平, 陈国平, 等. AngioJet血栓清除术在急性下肢动脉缺血治疗中的应用. 介入放射学杂志, 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.	韩新强, 王雪敏, 马超, 等. AngioJet机械血栓清除术后血红蛋白尿的原因分析. 中国介入影像与治疗学, 2017, 14(4): 218-222.
24.	唐勇, 陈健, 周卿, 等. 不同水化方案预防造影剂肾病临床研究. 中华实用诊断与治疗杂志, 2013, 27(8): 783-785.
25.	卞路, 殷世武, 倪才方, 等. AngioJet血栓清除系统治疗急性肢体缺血19例. 介入放射学杂志, 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. 张雷, 陆清声, 裴轶飞, 等. AngioJet机械血栓抽吸技术在动脉栓塞及血栓形成中的应用体会. 中国血管外科杂志(电子版), 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. 张希全, 凌宝存, 朱伟, 等. 介入性腔内机械性血栓碎吸及溶栓术治疗周围动脉急性血栓栓塞. 中国介入影像与治疗学, 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. 潘升权, 殷世武, 龙海灯, 等. Angiojet血栓清除导管在急性动脉栓塞治疗中的应用体会. 安徽医学, 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. 廖传军, 杨宝钟, 张望德, 等. 外科治疗非创伤急性下肢缺血154例. 中华外科杂志, 2008, 46(22): 1716-1719.
9. 黄晓钟, 张纪蔚. 下肢动脉栓塞的置管溶栓治疗. 临床外科杂志, 2013, 21(5): 326-328.
10. 商春雨, 张莉, 张立明. Fogarty球囊导管取栓联合股动脉置管溶栓治疗急性下肢动脉栓塞的疗效评价. 中国实用医药, 2017, 12(32): 74-75.
11. 张惠林, 殷世武, 项廷淼, 等. Angiojet血栓抽吸系统联合置管溶栓对急性肢体动脉栓塞性疾病的临床疗效. 实用医药杂志, 2017, 34(10): 883-885.
12. 解志磊, 徐敦元, 王文利, 等. AngioJet机械血栓抽吸术在急性下肢缺血中的应用体会. 血管与腔内血管外科杂志, 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, 阴继凯, 等. AngioJet治疗急性髂股静脉血栓形成的早期疗效分析. 中国血管外科杂志(电子版), 2016, 8(4): 303-305, 313.
19. 郭建明, 郭连瑞, 崔世军, 等. AngioJet血栓抽吸联合支架成形治疗腋静脉-锁骨下静脉血栓形成1例. 介入放射学杂志, 2019, 28(5): 465-467.
20. 孙立巍, 刘艳, 梁增辉. AngioJet血栓抽吸装置联合CDT对急性下肢动脉缺血的疗效研究. 中国循证心血管医学杂志, 2019, 11(2): 205-208.
21. 公茂峰, 顾建平, 陈国平, 等. AngioJet血栓清除术在急性下肢动脉缺血治疗中的应用. 介入放射学杂志, 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. 韩新强, 王雪敏, 马超, 等. AngioJet机械血栓清除术后血红蛋白尿的原因分析. 中国介入影像与治疗学, 2017, 14(4): 218-222.
24. 唐勇, 陈健, 周卿, 等. 不同水化方案预防造影剂肾病临床研究. 中华实用诊断与治疗杂志, 2013, 27(8): 783-785.
25. 卞路, 殷世武, 倪才方, 等. AngioJet血栓清除系统治疗急性肢体缺血19例. 介入放射学杂志, 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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