Summary:Background: The aim of this prospective single-centre study was to analyse the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries and bypasses, as well as to evaluate long-term outcomes of this method. Patients and methods: Patients with acute (duration of symptoms < 14 days) or subacute (duration of symptoms > 14 days and < 3 months) occlusions of peripheral arteries and bypasses were selected consecutively for treatment. The cohort consisted of 113 patients, aged 18 -92 years (median 72 years). In all, 128 procedures were performed. Results: Angiographic success was obtained in 120 interventions (93.8 %). Reasons for failures were rethrombosis of a partially recanalised segment in six procedures, and embolism into crural arteries in one intervention -percutaneous aspiration thromboembolectomy (PAT) and/or thrombolysis were ineffective in all these cases. Breakage of the Rotarex catheter happened in one procedure. Embolisation into crural arteries as a transitory complication solvable with PAT and/or thrombolysis occurred in four cases. Rethrombosis was more frequent in bypasses than in native arteries (p = 0.0069), in patients with longer occlusions (p = 0.026) and those with poorer distal runoff (p = 0.048). Embolisation happened more often in patients with a shorter duration of symptoms (p = 0.0001). Clinical success was achieved in 82.5 %. Major amputation was performed in 10 % of cases. Cumulative patency rates were 75 % after one month, 71 % after six months, 38 % after 12 months, 33 % after 18 months and 30 % after 24, 30, 36 and 42 months. Conclusions: Rotarex thrombectomy has excellent immediate results with a low rate of failures and complications. In comparison to thrombolysis, it enables the fast and effi cient treatment of acute and subacute occlusions of peripheral arteries in one session.

The Rotarex system enables fast and efficient treatment of peripheral arterial thromboembolic occlusions. In most cases, this method is capable of replacing thrombolysis.

A case report of a patient with unusual compressive syndrome is reported herein. A 27-year-old woman was referred to our hospital due to intermittent claudication in the left thigh and calf which gradually developed over the last five months. Angiography showed an atypical short occlusion of the external iliac artery. Only surgical revision made an exact diagnosis. The formation compressing the artery was a ganglion that originated from the hip joint and adhered to the artery. Resection of the ganglion was carried out. The adjacent segment of the artery was removed and replaced by end-to-end venous graft using vena saphena magna. From the operation until present (30 months) the patient remains symptom-free. To our knowledge a hip joint ganglion compressing the artery and causing symptoms of peripheral arterial disease has not been previously reported in medical literature.

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