Application Of AngioJet Mechanical Thrombus Clearance System In Acute Arterial Ischemia Of Lower Extremities

Purpose:To explore the effectiveness and safety of Angio Jet mechanical thrombus learance system in acute arterial ischemia of the lower extremity.Method:11 patients with acute arterial ischemia of the lower extremity from October 2016 to April 2017 in Ji’nan Central Hospital Vascular Surgey were enrolled.A total of 11 cases,male 8 cases,female 3 cases,the average course of disease:3.09 + 2.12 days,mean age:72.64 + 8.03 years,6 cases with smoking history,8 cases with hypertension,5 cases with 2 diabetes,4 cases of patients with ischemic heart disease,4 cases with atrial fibrillation,1 patients with rheumatic heart disease,according to the WIFi grade of ischemia,0 cases of grade 0,grade 1 in 0 cases,6 cases of grade 2,grade 3 in 5 cases,according to the ischemic plane,2 cases of iliac artery superficial femoral artery 7 plane plane cases,2 cases of popliteal artery.Use of low molecular weight heparin for anticoagulation immediately after exclusion of contraindications.use angiojet divice to remove thrombus(usually repeat1-3 times).When the operator is unsatisfied with the degree of thrombus clearance,or,a hidden arterial plaque was appear,or a flow-limmiting arterial dissection occur,the ballon or stent should be used.If the thrombus or arterial plaque were flushed to the far end,percutaneous transluminal angioplasty(PTA)was necessary.The angiography images were measured and compared before and after thrombus aspiration,used to calculate the thrombus clearance rate.The treatment of anticoagulant,anti-platelet aggregation and anti-reperfusion trauma were continued after operation.ABI,NRS pain scores and lower extremity arterial color Doppler were followed up at 1 months,3 months and 6 months after the operation.To evaluate the efficacy and safety of Angio Jet mechanical thrombectomy system based on thrombus clearance rate,WIFi classification and incidence of postoperative adverse events.Result:A total of 11 patients received mechanical thrombectomy for Angio Jet,including 4patients(36.4%)who received simple Angio Jet thrombectomy,7 patients(63.6%)underwent Angio Jet thrombectomy and +PTA treatment,4 patients(36.4%)received PTA+ stent implantation after thrombus clearance.All patients were carried out more than 2 times.the mean thrombus aspiration times,(2.27+0.47),mean aspiration time(242.19+ 73.63s),mean aspiration volume(273.33+91.83ml).The rate of thrombus clearance was(78.65%±12.62%),Technical success rate100%(11/11),with a total success rate of 9%(1/11)and a partial success rate of 91%(10/11).The clinical success rate was 81.81%(9/11).The WIFi ischemic grade of the patients was increased from 5 cases of grade 3(45.45%),6 cases of grade 2(54.55%)to 2 cases of grade 2(18.18%),7 cases of grade 1(63.64%),2 cases of grade 0(18.18%).After the operation,the ABI of patients was increased from(0.36±0.11)to(0.71±0.09),and P < 0.05 had significant statistical difference.4 cases(36.36%)had different degrees of hemoglobinuria,but no renal failure occurred.4 cases(36.36%)had different degrees of ischemia and reperfusion injury of the affected limbs(foot),and all of them were given Aescuven Forte to alleviating swelling.No severe renal function injury,no major cardio cerebral vascular events,no death cases.At 1,3,and 6 months after operation,the patients’ ABI were 0.71 + 0.09,0.70 + 0.09 and 0.66 + 0.08,and the NRS scores were 0.64 + 0.81,0.64 + 0.79 and 1.36 +1.03.Conclusion:Acute arterial ischemia in the lower extremities is urgent,rapid,and high-risk in disability,which is a rather difficult problem in clinical treatment.The Angiojet thrombus clearance system used in this study has both functions of thrombolysis and thrombectomy.It avoids the risk of trauma and infection caused by open surgery,reduces the usage of urokinase,and has a good application prospect in clinical treatment.The preoperative and postoperative comparison and short-term follow-up data indicate that the Angio Jet system is effective and safe in the treatment of acute arterial ischemia of the lower extremities.However,our study has not been compared with Fogarty catheter embolectomy and catheter directed thrombolys is(CDT).Because of the small sample size and short follow-up time,the long-term efficacy and cost-effectiveness of this study still need to be studied.