Thrombolysis and mechanical thrombectomy for arterial disease

The practice of vascular surgery in today’s world continues to change at a rapid pace, driven largely by technologic advances in endoluminal instrumentation. Until relatively recently, endarterectomy or bypass were the only treatment options available for chronic arterial occlusive disease, a condition now more often treated endoluminally with angioplasty and stenting. In the acute situation, where a significant component of the obstruction is likely to be relatively fresh thrombus, angioplasty is less advisable due to risk of embolization and the long lengths of vessel typically involved. Previously only able to be treated with open balloon catheter thrombectomy, vascular surgeons (VSs) today have both thrombolytic drugs and percutaneous mechanical thrombectomy devices at their disposal to treat both chronic and acute arterial occlusions. Although thrombolytic agents such as urokinase (UK) and tissue plasminogen activator (t-PA) have a long history of efficacious use, the exact indications and expectations of their use remains controversial [1]. More recently, percutaneous mechanical thrombectomy devices capable of treating a variety of vessel sizes and types have been developed, further expanding the spectrum of options to treat intravascular thrombosis. Although the available devices differ in their manner of clot dissolution and ability to extract the lysed thrombus, all allow for percutaneous recanalization of thrombosed vessels, and provide an additional therapeutic option, either used in stand-alone fashion or as an adjunct to pharmacologic thrombolysis [2]. Although each method has its merits as a stand-alone therapy, it is becoming clear that a combination of both thrombolysis and mechanical thrombectomy has many practical advantages. This article will summarize the reported experience with both thrombolysis and mechanical