Aspiration thrombectomy to treat acute femoral thrombosis in a preexisting stenosis

Clinical History

Acute thrombosis of superficial femoral artery due to a preexisting femoral stenosis

Imaging Findings

The patient presented with acute left lower limb ischemia. He was suffering from absolute arrythmia and was on continuous warfain medication. On admission his Quick level was 40%. Clinical diagnosis of embolic arterial occlusion was made, left popliteal pulse was absent. Antegrade femoral puncture was performed and angiography was performed showing a short segment occlusion of the superficial femoral artery with preexisting collaterals feeding the patent popliteal artery and fibular artery as the only artery left for supply of the lower limb (Fig. 1). Angiography changed the diagnosis to acute femoral thrombosis due to a prexisting femoral stenosis.

Discussion

An 8F sheath with removable hub (Cook Inc.) was introduced and aspiration thrombectomy of the short thrombotic occlusion (Fig 2) was made. After two aspirations, the original stenosis was demasked (Fig.2c) and a balloon dilatation of the underlying stenosis was performed rsulting in recanalization of the femoral artery (Fig. 3) was achieved. No downward embolization occurred. Aspiration embolectomy is a straight-forward technique to remove acute thrombus from femoral and lower limb arteries. Especially in embolic disease, it is a very effective tool that allows rapid removal of occluding thrombi on a low cost basis. Using instruments down to 4 F, it can be easily achieved into all limb arteries including those of the calf. To allow safe removal of thrombus, a sheath with a removable hub is mandatory, which are available by Cook Inc. and Cordis Inc. For popliteal thombi and emboli, an 8 F aspiration catheter, for calf arteries, aspiration catheters of 4 to 6 F are recommended. Alternative treatment includes thrombolysis in different modifications or mechanical thrombectomy using hydrodynamic or mechanical systems.

Differential Diagnosis List

Final Diagnosis

Aspiration thrombectomy from the superficial femoral artery

URL:	https://eurorad.org/case/598
DOI:	10.1594/EURORAD/CASE.598
ISSN:	1563-4086