Cardiovasc Intervent Radiol (2013) 36:936–942
DOI 10.1007/s00270-012-0507-9
CLINICAL INVESTIGATION
Recanalization of Acute and Subacute Venous and Synthetic
Bypass-Graft Occlusions With a Mechanical Rotational Catheter
Christian Wissgott • Peter Kamusella •
Reimer Andresen
Received: 31 July 2012 / Accepted: 29 September 2012 / Published online: 14 November 2012
Ó Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012
Abstract
Purpose Percutaneous mechanical thrombectomy (PMT)
is now established as an alternative treatment of acute
arterial occlusions in addition to fibrinolysis and surgical
thrombectomy. The objective of this retrospective study
was the investigation of a rotational atherothrombectomy
catheter in terms of safety and efficacy in the treatment of
acute and subacute femoropopliteal bypass occlusions.
Materials and Methods Forty-two patients (average age
65.8 ± 9.1 years) with acute (\14 days [n = 31]) and
subacute (14–42 days [n = 11]) femoropopliteal bypass
occlusions were treated consecutively with a rotational
debulking and removal catheter (Straub Rotarex). The
average occlusion length was 28.4 ± 2.9 (24–34) cm.
Thirty-four (81 %) patients underwent venous bypass, and
8 (19 %) patients underwent polytetrafluoroethylene
bypass.
Results The technical success rate was 97.6 % (41 of 42).
In 1 patient, blood flow could not be restored despite the
use of the atherothrombectomy system. The average cath-
eter intervention time was 6.9 ± 2.1 (4–9) min. Ankle-
brachial index increased from 0.39 ± 0.13 to 0.83 ± 0.11
at discharge and to 0.82 ± 0.17 after 1 month (p \ 0.05).
There were a total of 2 (4.8 %) peri-interventional com-
plications: One patient developed a distal embolism, which
was successfully treated with local lysis, and another
patient had a small perforation at the distal anastomosis,
which was successfully treated with a stent.
C. Wissgott (&)
P. Kamusella
R. Andresen
Institute of Diagnostic and Interventional Radiology/
Neuroradiology, Westküstenklinikum Heide—Academic
Teaching Hospital of the Universities of Kiel, Lübeck
and Hamburg, Esmarchstrasse 50, 25746 Heide, Germany
e-mail: cwissgott@wkk-hei.de
123
ARTERIAL INTERVENTIONS
Conclusion PMT with the Rotarex atherothrombectomy
catheter represents a safe and effective option in the
treatment of acute and subacute femoropopliteal bypass
occlusions because it can quickly restore blood flow.
Keywords Mechanical thrombectomy
Bypass
recanalisation
Atherothrombectomy
Acute occlusion
Introduction
Acute and subacute ischemia of the limbs is caused by a
decrease in arterial perfusion to a limb. In addition to the
risk of damage to or loss of a limb, this can give rise to life-
threatening complications for the patient due to anaerobic
local and ultimately systemic metabolic conditions.
Therefore, in additional to general intensive medical
measures, therapeutic management will include making a
decision regarding the most rapid, suitable revasculariza-
tion measure [1]. The situation is similar in patients with
femoropopliteal bypasses, especially P1 bypasses where it
makes no difference whether the bypasses are venous or
polytetrafluoroethylene (PTFE) [2–4].
Acute occlusions are divided into three stages according
to the criteria of the TASC Working Group, but so far,
there are no clear therapy recommendations [5]. Local lysis
is indirectly recommended in stages I and IIa with
mechanical thrombectomy as an alternative. In cases of
acute, limb-endangering ischemia (stages IIb and III),
immediate recanalization is necessary, usually by vascular
surgery, but mechanical thrombectomy also provides an
alternative in this case in particular.
Because the results of vascular surgery are often not
completely satisfactory and are also associated with
increased morbidity and mortality due to the necessary
C. Wissgott et al.: Recanalization of Bypass-Graft Occlusions 937

anesthesia [6, 7], local intra-arterial lysis has prevailed in Table 1 Risk profile and lesion characteristics of patients (n = 42)
randomized trials, at least in stages I and IIa, as the stan- Characteristics Value (%)
dard procedure [8–12].
However, even lysis therapy is associated with systemic Mean age ± SD/range (year) 65.8 ± 9.1/48–81
complications. It is complex and cost-intensive because Sex
patients must receive intensive medical care, some for Male 22 (52.4)
several days afterward the procedure [13]. Female 20 (47.6)
Currently various mechanical thrombectomy systems, Risk factors
which have the advantage of lower invasiveness, lower Smoker 26 (61.9)
complication rates, and shorter duration of treatment, are Arterial hypertension 30 (71.4)
available as an alternative treatment. Several devices are Hyperlipoproteinemia 16 (38.1)
offered and can be divided into two different physical Diabetes mellitus 21 (50.0)
action principles: (1) rotational debulking with or without Clinical classification
removal of the debris and (2) rheolytic thrombectomy Acute (\14 days) 31 (73.8)
[14–19]. Subacute (\42 days)a 11 (26.2)
The purpose of this study was to examine the results of Stage a 18 (42.9)
treatment of acute femoropopliteal bypass occlusions by Stage IIa 20 (47.6)
means of a mechanical rotational debulking and removal Stage IIb 4 (9.5)
system (Rotarex, Straub Medical AG, Switzerland) in Lesion characteristics
terms of efficacy and safety. Occlusion length/range (cm) 28.4 ± 2.9/24–34
Venous bypass 34 (80.9)
PTFE bypassb 8 (19.1)
Materials and Methods Access
Antegrade 34 (80.9)
Patients Crossover 8 (19.1)
6F 25 (59.5)
From 2008 to 2012, 42 patients with acute (start of
8F 17 (40.5)
symptoms \14 days [n = 31]) and subacute (start of
a
symptoms \42 days [n = 11]) femoropopliteal bypass Classification according to Rutherford for acute vessel occlusions
b
occlusions were consecutively treated with a rotational PTFE bypass
atherothrombectomy catheter (Rotarex). All cases were
above-knee P1 bypasses. Thirty-four (81 %) patients selected in 8 cases (19 %) because of large preponderance
underwent venous bypass, and 8 (19 %) patients underwent in these patients (Table 1). All patients were thoroughly
PTFE bypass. The mean age of the patients was informed about the treatment and gave their consent in
65.8 ± 9.1 years. writing (Figs. 1, 2, 3).
Patients were classified according to Rutherford criteria
[20] for acute ischemia. Eighteen patients (42.9 %) were Mechanical Thrombectomy
stage I; 20 patients (47.6 %) were stage IIa; and 4 patients
(9.5 %) were stage IIb. Table 1 lists the risk profiles and The system consists of three components: the Rotarex
lesions characteristics of the patients. catheter, a motor that is also used as a handle, and an
The primary inclusion criteria were as follows: (1) acute electronic control unit. The system is controlled by a
or subacute ischemia in stages I to IIb, (2) no relevant guidewire and is available in 8F and 6F sizes.
upstream lesion, (3) at least 1 peripheral outflow vessel, The Rotarex catheter is activated and, by rolling it back
and (4) safe intraluminal guidewire passage. Primary and forth between the fingers, pushed forward into the
exclusion criteria were as follows: (1) lack of a patent occlusion. The chisel-like facets on the catheter tip break
peripheral outflow vessel and (2) no intraluminal guidewire down the material. The catheter must be advanced slowly
passage possible. The decision for the percutaneous ath- to allow for the detached fragments to be hurled against the
erothrombectomy was made by a team comprised of an vessel walls by the strong vortex caused by the rotating
interventional radiologist, a vascular surgeon, and an head, where they loosen additional occlusion material on
angiologist. the walls without the rotating head of the catheter having to
The intervention was performed on 34 patients (81 %) touch them. The loosened fragments are then aspirated by
using the preferred antegrade puncture technique, and the strong suction, further broken up inside the head, and
contralateral access using the crossover technique was finally transported to a collecting bag outside of the body.

123
938 C. Wissgott et al.: Recanalization of Bypass-Graft Occlusions

Fig. 1 Preinterventional
angiogram of 74-year-old
woman with an acute occlusion
of a femoropopliteal bypass-
graft. The proximal and distal
anastomes were previously
stented

Fig. 3 A–C Final result after recanalization with 8F Rotarex system

Fig. 2 A, B Documentation of recanalization of the bypass occlusion without any relevant residual stenosis. No additional treatment was
with an 8F-Rotarex-System necessary. No distal embolization was noted in the runoff vessels

123
C. Wissgott et al.: Recanalization of Bypass-Graft Occlusions
A driving and conveying screw similar to an ‘‘Archimedes
screw’’ operates the catheter head, produces the suction
power, and evacuates the loosened material. This helix
running along the inside of the catheter rotates at
40,000–60,000 rpm and transfers this rotation to the
working head. The helix is driven by a magnetic coupling
between the motor and the catheter. The rotation of the
screw drives the rotational head and at the same time
creates a permanent partial vacuum inside the catheter,
which aspirates thrombotic material into the cutting win-
dow, where it is broken up, and finally transports it through
the conveyor screw into a collecting bag. The aspiration
performance is approximately 1.25 ml/s with the 8F system
or 0.75 ml/s with the 6F system.
Intervention
All interventions were performed by two interventional
radiologists. After performing an angiogram using standard
technique, the nominal diameter of the vessel in the target
lesion was estimated, and it was decided which rotational
catheter caliber to use to perform the procedure. Target
lesions with a maximum nominal vessel diameter of 5 mm
must be treated, according to the manufacturer’s instruc-
tions, with the Rotarex 6F. Those with a minimum nominal
vessel diameter of 5–8 mm must be treated with the Rotarex
8F. The smallest treatable vessel diameter is currently 3 mm
(with the Rotarex 6F), whereas the upper limit is 8 mm
(Rotarex 8F). A 6F or 8F sheath was used depending on the
caliber of rotational catheter to be used. Finally, the occlu-
sion was passed with a 0.035-inch hydrophilic coated
guidewire (Terumo stiff) using road-map imaging. This was
then exchanged for the 0.018-inch hydrophilic, Teflon-
coated guidewire (Angiotech [Denmark] or Straub Medical
AG) included with the Rotarex intervention set through a 4F
straight catheter (Boston Scientific). After this, 5,000 IU
heparin (UFH) were given. The Rotarex catheter was
introduced and activated shortly above the occlusion. Then
the occlusion was passed, under fluoroscopy, with small
forward and backward movements at an advancement speed
of 5 mm/s. After complete passage, the catheter was pulled
back, and a control angiogram was performed. Depending on
the result, as many as three Rotarex passes were conducted.
Finally, any remaining stenosis[30 % was treated by means
of percutaneous transluminal angioplasty (PTA) or, if nec-
essary, additional stent implantation (self-expanding nitinol
stents) (Figs. 1–3).
Technical success was defined as recanalization with
residual stenosis \50 % on angiographic control. After
completing the intervention, the puncture was closed using
a percutaneous closure system (StarClose or Perclose-
Proglide [both from Abbott, IL, USA]).
939
Medication
All patients received 100 mg acetylsalicylic acid (ASA)/d
before the intervention if long-term medication was not
already being given. During the intervention, as already
mentioned previously, 5,000 IU heparin were given, and
long-term medication with ASA 100 mg/day was given
postintervention. In the case of a stent implantation, 75 mg
clopidogrel (Sanofi Aventis, Germany) was also given for
6 weeks after a saturation dose of 300 mg was reached.
Follow-Up
All patients were routinely followed-up up before dis-
charge and after 1 month with clinical examination and
determination of the ankle-brachial index (ABI) as well as
optional color-coded duplex sonography. The follow-up
examinations were performed either by an interventional
radiologist or a vascular surgeon.
Statistics
All values are given as means ± SD or number (percent)
of patients. Significance was determined by means of
Student t test. The statistical analysis were performed by
the investigators.
Results
After Rotarex atherothrombectomy, the technical success
rate was 97.6 % (41 of 42 patients). In the 1 remaining
patient, no blood flow could be restored using Rotarex
atherothrombectomy despite successful wire probing.
Therefore, 24-hour local lysis was also performed with
alteplase (Actilyse; Boehringer Ingelheim, Germany). The
residual stenosis was seen after lysis was [95 %.
After percutaneous mechanical thrombectomy (PMT)
alone, a good recanalization result without relevant residual
stenosis was achieved in 26 patients (61.9 %); balloon
dilatation was ultimately performed in 16 patients (38.1 %);
and 5 patients (11.9 %) also underwent stent implantation
(Absolute Pro, Abbott Vascular [n = 2] or Maris, Invatec
Medtronic [n = 3]). PTA or stent implantation was neces-
sary either on the proximal or distal anastomosis of the
bypass. No residual thrombosis of the bypass was detectable
after rotational atherothrombectomy in any of the patients
experiencing technical success (Table 2). The average
occlusion length was 28.4 ± 2.9 (range 24–34) cm.
The total treatment time with the Rotarex athero-
thrombectomy catheter, from puncture start to full hemos-
tasis of the puncture site, was 52.7 ± 13.2 (range
35–75) min. The average catheter application time from first
123
940
Table 2 Results after Rotarex thrombectomy
Results Value (%)
Technical success rate 41 (97.6)
Rotarex (stand alone) 26 (61.9)
Additional procedures
PTA 16 (38.1)
Stent (self-expandable)a 5 (11.9)
Complications
Distal embolism 1 (2.4)
Perforation 1 (2.4)
a
Nitinol stents (Maris [Invatec] or Absolute Pro [Abbott])
insertion to final removal was 6.9 ± 2.1 (range 4–9) min
with 2.1 ± 0.4 (range 1–3) passages being conducted.
There was a significant clinical improvement in ABI
from before the intervention (0.39 ± 0.13) to 0.83 ± 0.11
at discharge and 0.82 ± 0.17 after 1 month (p \ 0.05).
The average length of hospital stay was 2.2 ± 0.71
(1–4) days. During the follow-up observation period, no
reinterventions on the affected limbs were necessary.
Complications
There were a total of two (4.8 %) complications. One
patient developed a distal embolism in the area of the distal
anterior tibial artery, which was successfully treated with
local short-term lysis (10 mg Alteplase for 20 min). At the
time, there was no critical ischemia because the posterior
tibial artery was properly perfused after recanalization of
the bypass. The other patient developed a small perforation
with mild contrast medium leakage in the area of the distal
anastomosis, which was successfully treated with pro-
longed balloon dilatation and stabilization of the vessel
wall with a bare metal stent (6 9 60-mm Maris, Invatec
Medtronic). There was no pseudoaneurysm or arteriove-
nous fistula. There were no amputations or deaths during
the follow-up observation period (Table 2).
Discussion
In this article, we report on the results of the treatment of
acute and subacute occlusions of femoropopliteal bypasses
using a mechanical rotational debulking-and-removal sys-
tem for PMT.
PMT was primarily conducted with a 6F system because
the majority of the bypasses treated were venous femoro-
popliteal bypasses with a lumen of approximately 5 mm.
The venous bypasses and the PTFE bypasses with a lumen
[5 mm were treated with an 8F system. Overall, we were
able to achieve a technical success rate in our cohort of
97.6 %, which is comparable with the results of Zeller
123
C. Wissgott et al.: Recanalization of Bypass-Graft Occlusions
et al. [21] and with those of further studies of the treatment
of acute and subacute occlusions with the Rotarex System
[22–24]. For cross-over procedures, we used a special
introducer (Balkin Up; Cook). This made successful con-
tralateral application of the rotational catheter possible in
all cases. In an earlier study with the system, breakage of
the driving and conveying screw during cross-over appli-
cation had been reported [21], but we did not experience
any breakage of the driving and conveying screw in any of
our cases, and this result is also confirmed by further
studies [24–26]. The technical success rate with the Rota-
rex system is also better than that after conventional local
lysis [8, 9].
After successful removal of the occlusion material, a
balloon dilatation was necessary in 38.1 % of cases. All
cases of additional treatment were located in the area of the
proximal and/or distal anastomosis. The bypass itself was
recanalized without residual thrombi in all technically
successful cases. In addition, stent implantation was nec-
essary in 11.9 % of patients due to residual stenoses. In the
studies already cited previously [21–23], the rate of addi-
tive therapies was higher, but these studies did not deal
with treatments of femoropopliteal bypasses exclusively.
Only Duc et al. [27] reported in a study on 38 patients of
whom only 2 patients required additional PTA and 5
patients stent implantation. The overall low rate of additive
therapy compared with local lysis confirms the potential of
the Rotarex catheter to also function as an ‘‘atherectomy
system’’ and treat the underlying stenosis, the ‘‘culprit
lesion,’’ at the same time. Some studies have already
shown the effectiveness of the Rotarex catheter in the
treatment of chronic lesions with a technical success rate of
well over 90 % [25, 26, 28]. The system has proven to
safely and effectively debulk and remove occlusion mate-
rial from acute to chronic occlusions while unmasking and,
at least partially, treating the culprit lesion. Hence, we have
started to refer to this device as an ‘‘atherothrombectomy’’
system.
No reintervention was necessary during the observation
period. There were no amputations or deaths. These values
are significantly better than those after conventional lysis
therapy or even after vascular surgery, where reinterven-
tion rates have been reported as 35 % [2, 3, 8, 9]. Our
amputation-free survival rate (100 %) is comparable with
the results of Zeller et al. and Duc et al. [21, 27].
Treatment time with the Rotarex atherothrombectomy
system is approximately 52.7 ± 13.2 min and is therefore
significantly faster than conventional local lysis, which
takes 24 h on average [8, 9], Surgical thrombectomy also
requires, on average, more time than Rotarex treatment, is
significantly more invasive, and is also associated with
increased complication rates, among other things, due to
the necessary anesthesia [8].
C. Wissgott et al.: Recanalization of Bypass-Graft Occlusions
The complication rate of 4.8 % observed by us is sig-
nificantly lower than that seen with conventional lysis and
vascular surgical therapy [7–9, 12], and is also less than the
19 % rate reported by Zeller et al. [21]. Both complications
that occurred were successfully treated during the inter-
vention and did not lead to a longer in-hospital stay for the
patients.
One advantage of this mechanical debulking-and-removal
system compared with lysis therapy is the lack of systemic
complications, such as bleeding in the brain and kidneys, etc.,
which have been reported in the large lysis studies [8, 9].
Therefore, monitoring of the patient in the intensive care unit
(ICU) is unnecessary, and thus the hospital stay is shorter.
With ultrasound-supported lysis, where significantly less
rt-PA is used, no systemic complications have occurred so
far. However, monitoring of patients in the ICU is still
necessary [29].
Under the German DRG system, to which we are subject,
the corresponding case-based lump sum makes Rotarex
possible to work cost-effectively [30]. Direct comparison of
the costs of mechanical atherothrombectomy with Rotarex
or local lysis is quite difficult because of the additional costs
of local lysis, e.g., longer stay in the ICU, additional angi-
ograms required, and longer hospitalization.
Potentially, the ThromCat XT System (Spectranetics,
The Netherlands) could be a technical alternative because it
also uses the ‘‘Archimedes screw’’ as its active principle,
but it shows a significantly lower efficacy due to its non-
rotating catheter head, among other things. In a mono-
centric study, a technical success rate of merely 70 % was
achieved, in which it was noted that occlusions with a
thrombus age [5 days could no longer be recanalized [31].
Another potential alternative could be the rheolytic
Angiojet System (Medrad, USA). The action mechanism of
the Angiojet catheter is based on the Venturi effect alone,
such that it has not been so successful as a ‘‘stand-alone
therapy’’ in previous publications but has shown satisfac-
tory results in combination with lysis through the catheter
as ‘‘power-spray lysis’’ [32, 33].
A comparison of the literature on the three most used
mechanical systems shows the highest effectiveness with
the widest range of thrombus or occlusion age for the
Rotarex system. The rate of additional PTA and/or stent
implantation is also the lowest for the Rotarex system [34].
Limitations of the presented study are that this was
retrospective analysis of a single-center experience with a
limited number of patients and a short follow-up period.
Conclusion
The mechanical debulking and removal of acute and sub-
acute occlusions of femoropopliteal bypasses represents a
941
safe and effective alternative to conventional lysis or vas-
cular surgery. The advantages of the Rotarex atheroh-
rombectomy catheter are (1) no relative or absolute
contraindications are known and (2) treatment time is
significantly shorter. Therefore, this method also offers a
good treatment choice for patients for whom local lysis is
contraindicated or who have an increased surgical risk.
Conflict of interest None.
References
1. Lavanier GL, Sacks D, Robinson ML (1992) Acute limb ische-
mia. Emerg Med Clin North Am 10:103–119
2. Aburhama AF, Hopkins ES, Wulu JT et al (2002) Lysis/balloon
angioplasty versus thrombectomy/open patch angioplasty of
failed femoropopliteal polytetrafluoroethylene bypass grafts.
J Vasc Surg 35:307–315
3. Van Damme H, Trotteur G, Dongelinger RF et al (1997)
Thrombolysis of occluded infrainguinal bypass grafts. Acta Chir
Belg 97:177–183
4. Comerota AJ, Weaver FA, Hosking JD et al (1996) Results of a
prospective, randomized trial of surgery versus thrombolysis for
occluded lower extremity bypass grafts. Am J Surg 172:105–112
5. Norgren L, Hiatt WR, Dormandy JA et al (2007) Inter-society
consensus for the management of peripheral arterial disease
(TASC II). Eur J Vasc Endovasc Surg 33:S1–S75
6. Sharafuddin MJA, Hicks ME (1997) Current status of percuta-
neous mechanical thrombectomy. Part 1. General principles.
J Vasc Interv Radiol 8:911–921
7. Dregelid EB, Stangeland LB, Eide GE et al (1987) Patient sur-
vival and limb prognosis after arterial embolectomy. Eur J Vasc
Surg 1:263–271
8. Ouriel K, Veith FJ, Sasahara AA (1998) A comparison of
recombinant urokinase with vascular surgery as initial treatment
for acute arterial occlusion of the legs. Thrombolysis or Periph-
eral Arterial Surgery (TOPAS) Investigators. N Engl J Med 338:
1105–1111
9. The STILE Investigators (1994) Results of a prospective ran-
domized trial evaluating surgery versus thrombolysis for ische-
mia of the lower extremity. Ann Surg 220:251–268
10. Bildsoe MC, Moradian GP, Hunter DW et al (1989) Mechanical
clot dissolution: new concept. Radiology 171:231–233
11. Blaisdell FW, Stelle M, Allen RE (1978) Management of acute
lower extremity ischemia due to embolism and thrombosis.
Surgery 84:822–834
12. Weaver FA, Comerota AJ, Youngblood M et al (1996) Surgical
revascularization versus thrombolysis for nonembolic lower
extremity native artery occlusions: results of a prospective ran-
domized trial. The STILE Investigators. Surgery versus Throm-
bolysis for Ischemia of the Lower Extremity. J Vasc Surg 24:
513–523
13. Palfreyman SJ, Michaels JA (1999) Vascular surgical society of
Great Britain and Ireland: systematic review of intra-arterial
thrombolytic therapy for peripheral vascular occlusions. Br J
Surg 85(5):704
14. Ritchie JL, Hansen DD, Vracko R, Auth DC et al (1986)
Mechanical thrombolysis: a new rotational catheter approach for
acute thrombi. Circulation 73:1006–1012
15. Drasler WJ, Jenson ML, Wilson GJ et al (1992) Rheolytic cath-
eter for percutaneous removal of thrombus. Radiology 182:
263–267
123
942
16. Reekers JA, Kromhout JG, van der Waal K (1993) Catheter for
percutaneous thrombectomy: first clinical experience. Radiology
188:8871–8874
17. Schmitz-Rode T, Gunther RW, Muller-Leise C (1991) US-
assisted aspiration thromboembolectomy: in vitro investigations.
Radiology 178:677–679
18. Sharafuddin MJA, Hicks ME (1998) Current status of percuta-
neous mechanical thrombectomy. Part 2. Devices and mechanism
of action. J Vasc Interv Radiol 9:15–31
19. Sharafuddin MJA, Hicks ME (1998) Current status of percuta-
neous mechanical thrombectomy. Part 3. J Vasc Interv Radiol 9:
209–224
20. Rutherford RB, Baker JD, Ernst C et al (1997) Recommended
standards for reports dealing with lower extremity ischemia.
Revisited version. J Vasc Surg 26:517–538
21. Zeller T, Frank U, Bürgelin K et al (2002) Langzeitergebnisse
nach Rekanalisation akuter und subakuter thrombotischer arteri-
eller Verschlüsse der unteren Extremitäten mit einem Rotations-
Thrombektomiekatheter. Fortschr Röntgenstr 174:1559–1565
22. Schmitt HE, Jäger KA, Jacob AL et al (1999) A new rotational
thrombectomy catheter: system design and first clinical experi-
ence. Cardiovasc Intervent Radiol 22:504–509
23. Jaeger KA, Schmitt EM, Schmitt HE (1999) Peripheral throm-
bectomy with the new Straub-RotarexÒ Catheter: A Multicenter
Study. Int Angiol (Suppl) 1:17A
24. Wissgott C, Kamusella P, Richter A et al (2008) Mechanical
rotational thrombectomy for treatment thrombolysis in acute and
subacute occlusion of femoropopliteal arteries: retrospective
analysis of the results from 1999 to 2005. Fortschr Röntgenstr
180:1–7
25. Wissgott C, Kamusella P, Andresen R (2011) Treatment of
chronic occlusions of the iliac or femoropopliteal arteries with
mechanical rotational catheters. Fortschr Röntgenstr 183:
945–951
123
C. Wissgott et al.: Recanalization of Bypass-Graft Occlusions
26. Wissgott C, Kamusella P, Andresen R (2011) Treatment of in-
stent reocclusions of femoropopliteal arteries with mechanical
rotational catheters. Fortschr Röntgenstr 183:939–944
27. Duc SR, Schoch E, Pfyffer M et al (2005) Recanalization of acute
and subacute femoropopliteal artery occlusions with the Rotarex
catheter: one year follow-up, single center experience. Cardio-
vasc Intervent Radiol 28(5):603–610
28. Silingardi R, Cataldi V, Moratto R et al (2010) Mechanical
thrombectomy in in-stent restenosis: preliminary experience at
the iliac and femoropopliteal arteries with Rotarex system.
J Cardiovasc Surg 51:543–550
29. Wissgott C, Richter A, Kamusella P et al (2007) Treatment of
critical limb ischemia using ultrasound-enhanced thrombolysis
(PARES Trial): final results. J Endovasc Ther 14:438–443
30. Nolte-Ernsting C, Abel K, Krupski G et al (2006) Wirtschaftliche
Evaluation angiographischer Interventionen einschließlich einer
radiologischen stationären und ambulanten Patientenbetreuung.
Fortschr Röntgenstr 178:78–89
31. Deák Z, Strube H, Sadeghi-Azandaryani M, Reiser MF et al
(2011) Rotational thrombectomy of acute peripheral vascular
occlusions using the ThromCat XT device: technique, indications
and initial results. Diagn Interv Radiol 17:283–289
32. Kasirajan K, Gray B, Beavers FP et al (2001) Rheoltic throm-
bectomy in the management of acute and subacute limb-threat-
ening ischemia. J Vasc Interv Radiol 12:413–421
33. Allie DE, Hebert CJ, Keller VA et al (2004) Novel simultaneous
combination chemical thrombolysis/rheolytic thrombectomy
therapy for acute critical limb ischemia: the power-pulse spray
technique. Catheter Cardiovasc Interv 63:512–522
34. Wissgott C, Kamusella P, Andresen R (2011) Percutaneous
mechanical thrombectomy: advantages and limitations. J Cardio-
vasc Surg 52:477–484