Endovascular salvage for distal embolization following percutaneous lower extremity intervention
Rafael Santini-Dominguez, Antanina Voit, Khanjan H. Nagarsheth.
University of Maryland Medical Center, Baltimore, MD, USA.
OBJECTIVES: Iatrogenic distal embolization (IDE) can occur following percutaneous coronary or lower extremity interventions (PCEI) and can result in acute limb ischemia (ALI). Herein, we present a series of IDE following PCEI that were successfully managed with percutaneous suction embolectomy using a commercially available suction catheter system.METHODS: This is a retrospective chart review of five consecutive patients were treated for IDE following PCEI. There were 4 females and 1 male with an age range of 62 to 82 years old. Demographic data, comorbid conditions, procedural details and complications were all assessed and analyzed. RESULTS: Of the patients treated, 80% presented with Rutherford 2A ALI and 20% with 2B ischemia following PCEI. Peripheral vascular intervention resulted in PCEI in 60% of patients evaluated and cardiac intervention accounted for 40%. Using the Penumbra Indigo suction embolectomy system complete revascularization was achieved in 100% of the study group. Vessels treated included; common femoral, superficial femoral, profunda femoral, popliteal, tibioperoneal trunk and peroneal arteries. Adjunct catheter directed thrombolysis was only used in 1 patient. Mean pre-operative ankle brachial index (ABI) was 0.25 and mean post-operative ABI was 0.98. Average length of hospital stay was 3.6 days. There were no mortalities, no fasciotomies, no amputations and no bypass surgeries needed for limb salvage. All patients returned to pre-procedural functional status at follow up. CONCLUSIONS: Percutaneous suction embolectomy with the Penumbra Indigo system for iatrogenic distal embolization after percutaneous coronary or lower extremity intervention can be performed safely with excellent rates of limb revascularization.
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