Patient Presentation

A 53-year-old man presented with 2-week onset of rest pain. Noninvasive studies suggested occlusive thrombus disease throughout the superficial femoral artery (SFA) and popliteal artery. The initial angiogram confirmed organized thrombus throughout the SFA and popliteal arteries (Figure 1).

Figure 1. Initial angiogram.

Treatment

The initial procedural strategy was to drip tPA overnight. After 24-hour tPA treatment, the patient’s foot appeared slightly improved and warmer to the touch; however, the follow-up angiogram did not indicate improvement of flow (Figure 2). It was decided that percutaneous mechanical thrombectomy with the Pounce™ Thrombectomy System should be attempted. For the first pass, the Pounce™ System baskets were deployed in the popliteal artery and the funnel catheter was deployed in the common femoral artery. The baskets were retrieved into the funnel and the Pounce™ System was withdrawn from the patient, successfully removing organized thrombotic material. Subsequent angiography showed thrombus at the tibioperoneal trunk (TPT) and an atherosclerotic lesion in the SFA (Figure 3). Another pass with the Pounce™ System was made at the TPT (Figure 4), followed by angioplasty at the TPT, resulting in tibial runoff to the foot (Figure 5). Attention was then directed to the lesion in the SFA, where atherectomy and angioplasty using a drug-coated balloon (DCB) were performed.

Figure 2. Angiogram after 24-hour pharmacomechanical treatment.

Figure 3. Angiography after single Pounce™ Thrombectomy System pass revealed residual atherosclerotic lesion at proximal SFA (A) and thrombus at the TPT (B).

Figure 4. TPT after one pass with the Pounce™ Thrombectomy System.

Figure 5. TPT after angioplasty.

Post-Procedure Outcome

The final angiogram (Figure 6) showed robust flow in the foot. The patient was discharged the same day as the Pounce™ Thrombectomy System procedure with a proper anticoagulation regimen. The physician noted that the Pounce™ System provided prompt clearance of organized thrombus to enable subsequent treatment of underlying atherosclerotic lesions.

Figure 6. Final angiogram revealed robust flow to the foot.

Caution: Federal (US) law restricts the Pounce™ Thrombectomy System to sale by or on the order of a physician. Please refer to the product’s Instructions for Use for indications, contraindications, warnings, and precautions. SURMODICS, POUNCE, and SURMODICS and POUNCE logos are trademarks of Surmodics, Inc. and/or its affiliates. Third-party trademarks are the property of their respective owners.

Vince Weaver, MD
Vascular Surgeon
Vascular Specialty Center
Baton Rouge, Louisiana
Disclosures: Consultant to Medtronic and Surmodics.