Aspiration Thrombectomy with the Indigo System for Acute Lower Limb Ischemia. Preliminary experience and analysis of parameters affecting the outcome

Background: The purpose of our study is to assess the short-term technical success and the safety of the Indigo System in a series of patients undergoing vacuum-assisted catheter direct thrombus aspiration (IS-CDTA) for acute lower limb ischemia (ALLI) and to evaluate which parameters may affect the outcome. Methods: All procedures using the IS-CDTA for ALLI, performed in a single-centre Interventional Radiology Unit from February 2016 to March 2020, were retrospectively analysed. Technical success was defined as the achievement of nearly-complete or complete revascularization (TIPI grade 2/3) and considered as a good outcome. Variables potentially correlated with the IS-CDTA outcome were analysed. Results: 33 procedures were performed in 29 patients. Mean age was 69 years old (range 47 - 88), 24 males (83%) and 5 females (18%). The technical success was 70%. Catheter-directed thrombolysis following IS-CDTA was performed in 23 cases and the overall technical success increased from 70% to 90%, afterwards. The median time between symptoms insurgency and IS-CDTA was significantly shorter in patients with good outcome (10 hours; IQR 2.75-48) compared to those with poor outcome (168 hours; IQR 36-336) (P = 0.003). No statistically significant differences were found between the two groups regarding ATK vs. BTK (P = 0.34), native vessel vs. graft (P = 0.25), occlusion nature P = 0.28) or Rutherford score (P = 0.80). Conclusion: IS-CDTA is a valid option for a rapid and percutaneous treatment of ALLI. Our experience indicates that the time elapsing from the symptoms insurgency and the endovascular procedure is the best positive predictor of the outcome

Extravascular Migration of Thrombosed Covered Stents after Endovascular Exclusion of Splenic or Hepatic Artery Aneurysms and Pseudoaneurysms: An Underestimated Phenomenon

Endovascular treatment of visceral artery aneurysms and visceral artery pseudoaneurysms might be performed with a wide range of devices. The use of covered stents (stent graft; SG) could be a valid treatment option in which both technical success and distal flow preservation can be achieved. However, SG occlusion might be both a short- and long-term complication, especially if implanted in the tortuous vessels. Moreover, even if not extensively described, SG occlusion can result in the extravascular migration of the device, as described in only 2 case reports to date