c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Image-Guided Thrombectomy in Vascular Surgery: 22

A D V E R T I S E M E N T

   
 

If a guidewire passes easily through the occlusion, it is likely to be fresh thrombus. In this case, a small balloon can be advanced over the wire and the balloon very gently inflated under a magnified fluoroscopic image.       

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Image-Guided Thrombectomy in Vascular Surgery: 23

A D V E R T I S E M E N T

   
 

With the first hint of balloon profile, it should then be withdrawn into the popliteal. It is helpful to to restrict all inflow from above so that the thrombus will not simply be pushed back into the tibial circulation. The small balloon can be inflated to a larger size once in the popliteal and if it can achieve profile in the popliteal and the SFA, withdrawn under fluoro guidance to the proximal arteriotomy. This will also avoid loss of the thrombus back into the tibial circulation.     

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Image-Guided Thrombectomy in Vascular Surgery: 24

A D V E R T I S E M E N T

   
 

If there is no tibial involvement, the balloon catheter used to shoot the original arteriogram is reinflated to achieve profile in the distal popliteal and slowly withdrawn with constant observation by fluoroscopy. If the balloon “hangs” on a stenotic or diseased area, traction is relaxed to a very light force and the balloon is gently deflated until it passes through the stenotic area. Once through, the balloon is reinflated to maintain profile in the non-stenotic area. The diseased/stenotic area can be marked for possible later angioplasty or stent therapy.     

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This page was last modified on 4/3/2002.