Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries.

Aim: To examine the efficacy and safety of the 6 French (6F) RotarexS catheter system in patients with acute limb ischemia (ALI) involving thromboembolic occlusion of the proximal and mid-crural vessels.

Methods: The files of patients in our department with ALI between 2015 and 2017 were examined. In seven patients, the RotarexS catheter was used in the proximal segment of the crural arteries. Data related to the clinical examination, Doppler sonography, angiography and follow-up from these patients were further used for analysis.

Results: Two patients (29%) had thrombotic occlusion of the common femoral artery, and the remaining five exhibited thrombosis of the superficial femoral artery and popliteal artery. Mechanical thrombectomy was performed in all cases using a 6F RotarexS catheter. Additional RotarexS catheter thrombectomy due to remaining thrombus formation with no reflow was performed in the anterior tibial artery in two of seven cases (29%), in the tibiofibular tract and posterior tibial artery in two of seven cases (29%) and in the tibiofibular tract and fibular artery in the remaining three of seven cases (43%). Ischemic symptoms resolved promptly in all, and none of the patients experienced a procedural complication, such as crural vessel dissection, perforation or thrombus embolization.

Conclusion: Mechanical debulking using the 6F RotarexS catheter system may be a safe and effective treatment option in case of thrombotic or thromboembolic occlusion of the proximal and mid-portion of crural arteries.