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Acute limb ischemia is a vascular emergency defined as a sudden decrease in limb perfusion associated with a risk of loss of viability of the affected extremity. Surgical treatment (Fogarty thromboembolectomy) is indicated only in suprainguinal occlusions. Other cases of acute and subacute limb ischemia should be managed percutaneously. Catheter-based treatment involves local thrombolysis and percutaneous mechanical thrombectomy (PMT). There are several devices in use for PMT; of them, the Rotarex system appears to be the most useful. There are no randomized studies comparing thrombolysis and PMT. Only indirect comparison is possible. The immediate and long-term results of PMT using the Rotarex device are probably more favorable than those following thrombolysis. Particularly for older and polymorbid patients, it may be significant that PMT, in comparison with thrombolysis, can restore blood flow faster and in one session; no contraindications for PMT in contrast to potentially life-threatening complications in thrombolysis exist, and there is also no need for observation in intensive care unit after PMT. Hospital stay after PMT is shorter. There is only one exception when thrombolysis cannot be replaced by Rotarex PMT - in the case of crural arteries involvement - due to the catheter size. In our opinion, PMT is superior to thrombolysis in the treatment of acute and subacute limb ischemia. Thrombolysis should be considered only in special cases, e.g. in crural arteries occlusions or in failure of mechanical thrombectomy.

MeSH
ischemie patofyziologie terapie MeSH
končetiny krevní zásobení patofyziologie MeSH
lidé MeSH
miniinvazivní chirurgické výkony MeSH
regionální krevní průtok MeSH
trombektomie metody MeSH
trombolytická terapie metody MeSH
Check Tag
lidé MeSH
Publikační typ
časopisecké články MeSH
přehledy MeSH

Článek

Laser angioplasty of peripheral arteries: basic principles, current clinical studies, and future directions

Stanek, Frantisek
Autor Stanek, Frantisek Department of Cardiology, Charles University, 3rd School of Medicine, Prague, Czech Republic

Diagnostic and interventional radiology. 2019 ; 25 (5) : 392-397. [pub] -

Diagn Interv Radiol
ISSN 1305-3612
Medvik
Zdroj

Percutaneous transluminal angioplasty (PTA) is a routine procedure for the treatment of peripheral arterial disease. However, its main limitation is late restenosis occurring at a 1-year rate of 6%-60%. Restenosis arises from injury to the arterial wall including overstretching, compression and rupture of the atherosclerotic plaque during balloon inflation. It is hypothesized that better long-term angioplasty results are observed if atherosclerotic plaques are removed rather than compressed and fractured. Laser angioplasty is one method to remove atherosclerotic plaques. We discuss the principles of lasers, physical properties of laser light, history of laser angioplasty and effects of laser radiation on tissues. Large clinical studies using laser angioplasty are critically assessed. In comparison to conventional PTA, there are some advantages of laser angioplasty: easier passage through chronic and calcified occlusions and according to some studies, better short- and medium-term results regarding limb salvage and management of in-stent restenoses.