Acute limb ischemia and aortic thrombosis
How would you treat this 61-year-old woman referred for acute limb ischemia, rutherford IIa, pain and right motor deficit 3/5? Join the medical team in the discussion!
Professor of Vascular Surgery
President of the association of the french university hospitals for clinical research
Conflicts of interest:
Research funding from Predisurge, Biotronik, WL Gore, GE Healthcare
Honoraria from Abbott, BD, Bentely, Biotronik, Boston Scientific, Cook, Eclevar Medtech, GE Healthcare, Ivascular, Medtronic, Penumbra, Sensome, Shockwave medical, WL Gore (consulting, medical advisory board, educational course, speaking)
- Woman, 61-year-old
- Severe Obesity IMC > 40
- Ischemic cardiomyopathy with stent
- Mitral valve surgery
- Abdominoplasty
- OSAS
- Ischemic stroke with left hemiparesis
Present state
- Acute Limb Ischemia (1 week)
- Rutherfod IIa
- Pain and right motor deficit 3/5
Hospitalization, heparin IV and pre operative assessment for aortic surgery (cardiac evaluation), BUT clinical deterioration on D2 with a complete right deficit (Rutherford IIb).
Endovascular is an alternative option to surgery
- Thromboaspiration with catheter or with Pump (Penumbra)
- Mechanical thrombectomy (Angiojet, Rotarex)
- Fibrinolysis
Thrombo-aspiration Penumbra Indigo® Lightning / Cat7
Penumbra, Alameda, CA, USA
Procedure
- Local anesthesia and sedation
- Percutaneous bilateral access with ultrasound
- 7F Introducer
- Penumbra Lightning
- Covered stents : Viabahn and Begraft
- Percutaneous closure devise (femoseal)
Day 1
- No pain
- Hot foot, well vascularized
- Motor recovery
Postoperative and follow up
- No adverse event
- Duration of stay : 4 days
- Etiologic check-up : chest scan, Holter, echocardiography …
- Long term anticoagulant treatment
- 1 month post op follow up
Conclusion
Thromboaspiration with Penumbra:
- Is a safe and effective alternative option to surgery even for aortic thrombosis
- Under local anesthesia with percutaneous access
- To avoid aortic surgery in patients with severe obesity or ischemic cardiomyopathy
- To avoid fibrinolysis and his specific complications
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