1. How to do endovascular mechanical thrombaspiration
Prof. t. zahariev, md
“St. ekaterina” university hospital, sofia
“deva maria” hospital, burgas

2. When do we use mechanical thrombaspiration?
Endovascular mechanical thrombaspiration is our first
choice treatment for a large variety of pathologies:
acute/subacute occlusions of native arteries
chronic occlusions of native arteries
occlusions of bypass grafts
in-stent rethrombosis
deep vein thrombosis

3. ROTAREX AND ASPIREX

4. OUR EXPERIENCE Type of occlusion Patients
Acute/subacute (<14d.) SFA and PA
12 (13,1%)
Chronic SFA and PA
47 (51,1%)
In-stent iliac
11 (11,9%)
In-stent SFA and PA
17 (18.5%)
Prosthetic FPBPG
5 (5,4%)
92 (100%)

5. OUR EXPERIENCE Type of occlusion Mean length Stent rate
NATIVE ARTERIES
Type of occlusion
Mean length
Stent rate
Primary patency
Secondary patency
1y.
2y.
Acute/subacute (<14d.) SFA and PA
88 mm.
25,0%
(3/12)
75,0%
(9/12)
58,3%
(7/12)
91,7%
(11/12)
83,3%
(10/12)
Chronic SFA and PA
115 mm.
38,3% (18/47)
70,2%
(33/47)
55,3%
(26/47)
87,2%
(41/47)
78,7%
(37/47)

6. IN-STENT REOCCLUSIONS
OUR EXPERIENCE
IN-STENT REOCCLUSIONS
Type of occlusion
Mean length
Stent rate
Primary patency
Secondary patency
1y.
In-stent iliac
73 mm.
27,3%
(3/11)
72,7%
(8/11)
90,9%
(10/11)
In-stent SFA and PA
168 mm.
29,4%
(5/17)
47,1%
(8/17)
58,8%
(10/17)

7. BYPASS GRAFT RETHROMBOSIS
OUR EXPERIENCE
BYPASS GRAFT RETHROMBOSIS
Type of occlusion
Stent rate
Primary patency
Secondary patency
1y.
Prosthetic FPBPG
60,0%
(3/5)
80,0%
(4/5)

8. OUR EXPERIENCE Type of occlusion Amputations Mortality
MAJOR COMPLICATIONS
Type of occlusion
Amputations
Mortality
Acute/subacute (<14d.) SFA and PA
Chronic SFA and PA
In-stent iliac
In-stent SFA and PA
1/17 (5,9%)
Prosthetic FPBPG
1/5 (20%)
2/92 (2,2%)
1/92 (1,1%)

9. OUR EXPERIENCE Type of occlusion Perforations Distal embolisation
MINOR COMPLICATIONS
Type of occlusion
Perforations
Distal embolisation
Acute/subacute (<14d.) SFA and PA
1/12 (8,3%)
Chronic SFA and PA
3/47 (6,4%)
1/47 (2,1%)
In-stent iliac
In-stent SFA and PA
1/17 (5,9%)
Prosthetic FPBPG
5/92 (5,4%)
1/92 (1,1%)

10. OUR EXPERIENCE Easy handling High primary success rate
pros
Easy handling
High primary success rate
Low heparin dose >> low bleeding risk
Low restenosis rate in native vessels
Reduced barotrauma due to ballooning
Restores contact of the blood with endothelial cells
Low stenting rate and shorter stents when needed
Wide indications: native arteries and veins, in-stent reocclusions, bypass grafts

11. OUR EXPERIENCE Intraluminal (not subintimal) passage of the guidewire
cons
Intraluminal (not subintimal) passage of the guidewire
It should not be used in arteries with heavily calcified plaques
Relatively large diameter – cannot be used in middle and distal segments of tibial arteries
Limited long-term patency is mainly due to the complexity of the underlying lesion
Unsolved problem with high reocclusion rate in in-stent and bypass lesions
During follow-up 10% bypass-rate in the in-stent occlusion group

12. CASE - CHRONIC OCCLUSION OF PA
Antegrade placement of a 11cm 6F sheath
Crossing of the occlusion with a inch Terumo J-wire supported by a 4F diagnostic catheter. Exchange of the guidewire for a stiff wire
2 passes of the occlusion with the 6F Rotarex catheter
Balloon dilatation 5/80 mm.

13. CASE – ISR SFA AND PA
Antegrade placement of a 11cm 8F sheath into the left CFA
Crossing of the occlusion with a inch Terumo J-wire guided by a diagnostic catheter. Exchange of the guidewire for a stiff wire
3 passes of the occlusion with the 8F Rotarex catheter

14. CASE – ISR SFA AND PA
Additional 6mm-balloon angioplasty of the middle part of the PA
No distal embolisation

15. CASE – PROSTHETIC FPBPG
Several passes of the occlusion with the 8F Rotarex catheter
Stenosis of the anastomosis in most cases
PTA or stent

16. THANK YOU FOR YOUR ATTENTION