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CC BY 4.0 · The Arab Journal of Interventional Radiology
DOI: 10.1055/s-0044-1782692
Original Article

Outcome of Secondary Interval Rheolytic Thrombectomy after Localized Intra-Arterial Catheter-Directed Thrombolysis through Power-Pulse Spray Technique in Cases of Partially Successful or Failed Primary Rheolytic Thrombectomy

Biswajit Sahoo 
1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Satyapriya Mohanty
2   Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Siddhartha Sathia
2   Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Rudra Pratap Mahapatra
2   Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Manoj Kumar Nayak
1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Ritesh Panda
3   Department of Plastic Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Manas Kumar Panigrahi
4   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Sourav Kumar Mishra
5   Department of Medical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Prakash Kumar Sasmal
6   Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Pankaj Kumar
6   Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
S Manawar Ali
6   Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Nerbadyswari Deep Bag
1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Saroj Kumar Das Majumdar
7   Department of Radiation Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Sandip Kumar Barik
7   Department of Radiation Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Sujata Devi
8   Department of Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Arunprakash Pitchaimuthu
1   Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Abstract

Objectives The aim of this study was to evaluate the safety and effectiveness of secondary interval AngioJet rheolytic thrombectomy after localized intra-arterial catheter-directed thrombolysis (CDT) through power-pulse spray (PPS) technique in partially successful or failed primary AngioJet rheolytic thrombectomy cases of acute and subacute peripheral artery thrombosis.

Materials and Methods This retrospective study included 12 acute (< 2 weeks) and subacute (2–4 weeks) peripheral arterial thrombosis patients who underwent primary thrombectomy alone without CDT and patients who received secondary thrombectomy after CDT through PPS at our institute between May 2022 and December 2022. Technical success, procedure-related complications (local and systemic), amputations, and 1-year patency were evaluated.

Results The angiographic success after primary thrombectomy was evaluated in 12 patients (9 acute and 3 subacute), and the results were categorized into three groups. Of 12 patients, complete success, partial success, and failure were noted in three (25%), five (41.7%), and four (33.3%) patients, respectively, after primary thrombectomy alone. Complete luminal patency was restored in all nine cases of partial success and failure in postprimary thrombectomy through adjunctive PPS thrombolysis and secondary thrombectomy. Technical and clinical success was achieved in all patients (100%). Transient hemoglobinuria was seen in five (41.7%) patients, and all had long-segment occlusion. At 1 year follow-up, no reocclusion, limb loss, or death was noted.

Conclusion Complete success after primary thrombectomy was more likely in the setting of short-segment occlusion and small-caliber arteries. In patients with partial success or failure after the primary thrombectomy alone, secondary thrombectomy may be performed after the adjuvant PPS thrombolysis to achieve complete recanalization.

Keywords

AngioJet rheolytic thrombectomy - Pharmacologic thrombolysis - power-pulse spray technique - Recombinant human tissue-type plasminogen activator - peripheral arterial occlusion

Ethical Approval Statement

Ethical approval was waived by the local ethics committee of our institute in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.


Authors' Contribution

B.S., P.S., S.M., S.S, and R.P.M. conceptualized and prepared the original draft preparation. M.K.N., R.P., M.K.P., P.K., S.M.A, N.D.B, S.K.M., S.K.B., S.D., S.K.D.M., and A.P. reviewed and edited the manuscript. All the authors have agreed with the submitted manuscript.




Publication History

Article published online:
19 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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