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Thrombectomy
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Device-based thrombectomy involves the excision of a thrombus using a device.
Percutaneous Mechanical Thrombectomy Combined with Thrombolysis for the Treatment of Deep Venous Thromboses
The following special CME section is underwritten through an educational grant from Possis Medical, Inc.
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The CIS "Power-Pulse Spray" Technique
The CIS "Power-Pulse Spray" Technique Feature: The CIS "Power-Pulse Spray" Technique - David E. Allie, MD Introduction Thrombus is now accepted as playing a key role in patients with acute myocardial infarction (AMI), unstable angina, acute coronary syndromes (ACS), deep venous thrombosis (DVT), pulmonary embolus (PE), and acute limb ischemia (ALI). technique is a novel combination therapy simultaneously utilizing RT (AngioJet) and CT (UK or TNK) which recently received FDA market clearance ...
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Treatment of Iatrogenic Renal Artery Perforation with a Covered Stent and Subsequent Rheolytic Thrombectomy
Treatment of Iatrogenic Renal Artery Perforation with a Covered Stent and Subsequent Rheolytic Thrombectomy Feature: Treatment of Iatrogenic Renal Artery Perforation with a Covered Stent and Subsequent Rheolytic Thrombectomy - Jeffrey M. Friedel, MD, Ramzi Khalil, MD, David Lasorda, MD Introduction Iatrogenic renal artery perforation is a rare, but well-described complication of percutaneous renal artery intervention.1-3 Treatment has traditionally involved surgical intervention including ...
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Dethrombosis of the Lower Extremities: Pharmacologic and Mechanical Techniques
Thrombus is widely present in the peripheral vasculature and its frequency depends on the patient?s clinical presentation. Thrombus is almost always present in acute critical limb ischemia (ALI) and is commonly found in patients with subacute presentations, chronic critical limb ischemia (CLI) and chronic occlusions. The approach to dethrombosing a vessel depends on multiple factors, including the age of the thrombus, but generally requires a combination therapy with chemical lysis and rheolytic thrombectomy, such as the use of Power-Pulse Spray (P-PS) technique, or atherectomy with dethrombosing capability such as the excimer laser. Surgery or chemical lysis as stand alone therapies carry very high rates of amputation and mortality. The role of embolic protection devices is still unclear but is promising, as embolization of atherothrombus continues to be a frequent occurrence during peripheral angioplasty. In this review, algorithms to treat thrombus in peripheral arterial disease are suggested.
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A Review of the Prevention and Management of Catastrophic Complications During Renal Artery Stenting
Renal artery rupture, renal artery dissection or aortic dissection may follow stent deployment. Renal Artery Dissection The creation of a renal artery dissection during stenting that results in a change in management of the patient is unusual. Renal Artery Rupture Renal artery rupture is one of the most feared, though fortunately, rare complications with renal artery stenting with a reported incidence of only 0?1.7%.
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Embolic Protection ? Its Role in Carotid, Coronary and Renal Intervention
The end-organ consequences of arteriosclerosis, namely heart attack, stroke and renal failure, are the leading cause of mortality and morbidity in the western world. Advances in percutaneous interventional techniques have meant that a fair proportion of this disease burden can be dealt with by percutaneous and nonsurgical options. Coronary angioplasty is an established way of dealing with simple and increasingly complex coronary disease. Carotid and renal stenting are also gaining favor as the preferred treatment options, compared to either medical therapy or surgical treatment. Overall, the endovascular approach to treating increasingly complex arterial atherosclerosis is increasing. As the use of stenting increases, so the drive to reduce potential complications and improve success rates intensifies. Although embolization from local atheroma has long been recognized as a potential complication in vascular surgery, direct evidence of this phenomenon was also observed during saphenous vein graft angioplasty. There is also evidence that similar embolization also occurs during carotid and renal stenting, and in certain native coronary lesions with a high thrombus burden. This review examines the rationale for the use of embolic protection systems during endovascular intervention and the clinical evidence base for their use. We also describe the different types of embolic protection systems currently available, their relative merits and outline recommendations for the current use of these devices.
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Arterial Kink and Damage in Normal Segments of the Superficial Femoral and Popliteal Arteries Abutting Nitinol Stents ? A Common Cause of Late Occlusion and Restenosis? A Single-Center Experience
Arterial Kink and Damage in Normal Segments of the Superficial Femoral and Popliteal Arteries Abutting Nitinol Stents ? Stenting across this area of bend with relatively stiff nitinol stents (stents that do not compress well longitudinally) can exacerbate the bend in the native artery at the ends of the stent and cause traumatic interaction between the native artery and the stent edge. A suboptimal angioplasty result led us to place a 7 mm x 150 mm Protégé stent in the old 6 mm x 100 mm ...
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Commentary: Dethrombosing Strategies and Endopharmacologic and Mechanical Techniques
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Combined Glycoprotein IIb/IIIa and Direct Thrombin Inhibition with Eptifibatide and Bivalirudin in the Interventional Treatment of Critical Limb Ischemia: A Safety and Feasibility Report
Objective: To evaluate the safety and feasibility of optimizing platelet inhibition and thrombin inhibition anticoagulation during peripheral vascular interventions (PVI) for patients with critical limb ischemia (CLI). Background: Glycoprotein (GP) IIb/IIIa inhibition combined with direct thrombin inhibition (DTI) with bivalirudin (Angiomax, The Medicines Company, Cambridge, Massachusetts) has shown decreased bleeding and ischemic complications in percutaneous coronary interventions (PCI). PCI benefits potentially applicable to CLI treatment include improved efficacy in diabetes, small complex vessels, microembolism reduction, and clinical outcomes. PVI cases have higher complications, more frequent reinterventions, and poorer outcomes than PCI. In CLI, a high incidence of diabetes, renal insufficiency, platelet dysfunction, hypercoagulability, inflammation, diffuse disease, and thrombus make DTI and eptifibatide (Integrilin, Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts) an attractive combination treatment. Methods: Between July 1, 2001 and August 1, 2004, 162 CLI patients underwent PVI utilizing bivalirudin (0.75mg/kg bolus with 1.75mg/kg/hr infusion) and eptifibatide (180 mcq/kg IV bolus and 2 mcq/kg/min for 12 hours) (group A) and were compared to a contemporary clinically matched heparin (UFH) control group without IIb/IIIa?s (group B). Results: The bivalirudin/eptifibatide group exhibited a statistically significant improvement (p = < 0.0001) in the variables of sheath removal time < 2 hours and length of stay < 72 hours vs. the UFH group. Trends towards significance were also exhibited in less major (3.7% vs. 5.5%) access site complications, 30-day thrombosis (1.8% vs. 4.3%), 6-month duplex ultrasound > 50% restenosis (17.3% vs. 24.7%), secondary reinterventions (11.7% vs. 16.0%), and 6-month limb salvage (92.6% vs. 87.6%, p = 0.1363). Conclusion: Combined eptifibatide and bivalirudin is a safe, feasible, and theoretically advantageous antiplate
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Is Endovascular Treatment Going to Put Open Surgery Out of Business?
Endovascular surgery, like other forms of minimally invasive surgery, has developed considerably over the last decade, following the trend set by laparoscopic surgery. Level I evidence to support this surge in interventional techniques has been less convincing. This article reviews the development of stenting and endovascular surgery, drawing comparisons between outcomes following open and endovascular procedures.
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