Purpose
TrellisTM Peripheral Infusion System is an over- a 0.035 guidewire compatible new device, designed to isolate a region of the peripheral vasculature to allow for lytic drug infusion and dispersion. We present our early experience using this system for the treatment of acute and subacute lower limb ischemia.
Methods and Materials
Four men (age: 54-77) with < 30 days iliac (n=1), femoropopliteal (n=2) arterial segment and femoropoliteal by pass graft (n=1) thrombosis were treated. The length of the occlusion ranged from 8-30 cm .The Trellis catheter was inserted percutaneously through an 8F sheath. The thrombosed vessel was isolated between inflated proximal and distal occluding balloons. The thrombus was saturated with 4-6mg rt-PA boluses injected through the infusion port of the catheter. The 0.035 guidewire was exchanged for the dedicated dispersion wire of the specific Oscillation Drive...
Results
There was 80-100% clot dissolution in all cases using a total of 9-14mg rt-PA. The duration of thrombolysis ranged from 35 60 minutes. In two cases self expandable stents were placed due to underlying stenoses. No complications were observed.
Conclusion
TrellisTM Peripheral Infusion System effectively isolates the targeted thrombosed segment in the peripheral arteries, delivers and rapidly disperses small amounts of rt-PA into the thrombus while simultaneously minimizing the risk of distal embolization. In addition, it potentially eliminates the continuous thrombolytic infusion thus accelerating the procedure.
References
1.Swischuk JL, Fox PF, Young K, et al. Transcatheter intraarterial infusion of rt-PA for acute lower limb ischemia: results and complications J Vasc Interv Radiol 2001;12: 423-430.2.Rao AK, Pratt C, Berke A, et al. Thrombolysis in myocardial infarction (TIMI) trial-phase1: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol 1988;11: 1-113.Verstraete M, Bounameaux H, De Cock, et al. Pharmacokinetics and systemic fibrinogenolytic effects of recombinant tissue-type plasminogen activator (rt-PA)...
Personal Information
E. KaragiannakidisD. Tsetis