Alexsander Shiferson

Short-term outcome analysis of radiofrequency ablation using ClosurePlus vs ClosureFast catheters in the treatment of incompetent great saphenous vein

BACKGROUND Radiofrequency ablation (RFA) is a widely accepted alternative to high ligation with proximal stripping of the great saphenous vein (GSV) in the treatment of lower extremity venous insufficiency. This study compared short-term outcomes of two generations of (VNUS Closure) RFA catheters, ClosurePlus (CP) and ClosureFast (CF). METHODS From February 2005 to April 2009, a total of 667 consecutive office-based RFA procedures were performed in our institution. CP catheters were used in the initial 312 lower extremity cases and CF catheters in the 355 cases that followed. The technique used for both catheters were as per the manufacturers recommendations. Postoperative duplex scans were completed to document the following endpoints: GSV obliteration; incidence of deep venous thrombosis (DVT); superficial venous thrombosis (SVT); and presence of loose or floating thrombus proximal to the treated GSV segment. RESULTS Of the 667 cases, 98% had available duplex scan studies within 1 week from completion of the procedure. Complete obliteration of the GSV on duplex scan studies was noted in 98% of 343 cases using the CF catheter and 88% of 312 cases using the CP catheter (P < .001). No case of DVT was detected in those treated with the CF catheter, whereas DVT occurred in 3.5% of cases treated with the CP catheter (P < .001). Incidence of SVT was 10% and 15%, respectively, for CF and CP (P < .08). Loose thrombus proximal to the GSV was identified in 7% of cases using CF and 6% of cases using CP (P = .80). No embolic episodes were observed clinically. CONCLUSIONS CF catheters are superior to CP catheters in terms of GSV obliteration and nonincidence of postoperative DVT. The absence of DVT may likely be due to the commencement of ablation at 2 cm from the GSV-common femoral vein junction.

Acute superior mesenteric artery embolism: reperfusion with AngioJet hydrodynamic suction thrombectomy and pharmacologic thrombolysis with the EKOS catheter.

Acute mesenteric ischemia is commonly treated by surgical exploration and open thrombectomy. Very few reports describe using newer, minimally invasive methods which utilize catheter-based mechanical and pharmacological thrombolysis. Herein, we report a case of acute superior mesenteric embolism successfully treated with AngioJet hydrodynamic mechanical thrombectomy and EKOS catheter pharmacological thrombolysis. A 76-year-old man with new onset atrial fibrillation presented with abdominal pain of 48 hours duration. Subsequent contrast computed tomography scan of the abdomen revealed a filling defect in the superior mesenteric artery (SMA), suggestive of an acute embolus, which was confirmed by SMA angiogram. The AngioJet aspiration device was used for hydrodynamic suction thrombectomy. The repeat angiogram demonstrated only a partial restoration of blood flow, and thus the EKOS tissue plasminogen activator catheter was left in the SMA for continuous thrombolysis. The patient underwent continuous thrombolysis for two days, with two subsequent sessions of angiography. Thereafter, the patient improved symptomatically and serum lactate was normalized. In conclusion, the AngioJet suction thrombectomy and pharmaco-mechanical thrombolysis using the EKOS catheter is associated with minimal morbidity and can be rapidly performed. It may be used as an alternative to open surgical thrombectomy in selected cases of acute SMA embolism.