Rotational thombectomy (Rotarex©) for(sub)acute limb ischemia – a safe approach

also in patients with diabetes mellitus?

M. Dufner, M. Kronlage, I. Printz, B. Heilmeier, E. Blessing, O. Müller, H. Katus, C. Erbel

Matthias Dufner

University Hospital Heidelberg, Germany

Disclosure

Speaker name:

Matthias Dufner

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

x Other(s): Educational Grant / Abbott

I do not have any potential conflict of interest

Objective

Compare the safety and efficacy of rotationalthrombectomy (Rotarex©) in patients with and

without diabetes mellitus.

source: straubmedical.com

Design

• Retrospective

• 2006-2015

• Single-center

• Dept. of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Germany

• Non-randomized

Study population

No Diabetes mellitus Diabetes mellitus p-value

absolut SD % absolut SD %

146 98 67,1 48 32,9

Characteristics

Age (years) 66,9 11,7 68,5 10,7 0,3148

Gender male 60 61,2 33 68,80,3744

female 38 38,8 15 31,2

Weight 70,9 14 80,7 12,3 0,0003

Comorbidities

Smoker 69 70,4 29 60,4 0,2273

Ischemic heart disease 35 35,7 31 64,6 0,0010

Arterial hypertension 70 71,4 43 89,6 0,0137

Kidney failure III-V 22 22,5 14 29,2 0,3763

Rutherford class

No Diabetes mellitus Diabetes mellitus p-value

absolut % absolut %

146 98 67,1 48 32,9

Rutherford class 3 68 69,4 27 56,0

0,1212

4 22 22,2 10 20,8

5 3 3,1 5 10,4

6 2 2,0 4 8,3

n.a. 3 3,0 2 4,2

No DM DM0

20

40

60

80

100

3

4

5

6

n.a.

Perc

en

tag

e (

%)

n.a.: information not available

Lesion characteristics

No Diabetes mellitus Diabetes mellitus p-value

absolut % absolut %

146 98 67,1 48 32,9

Major lesion

Native vessel 67 76,1 33 68,8 0,3508

Bypass 2 2,0 0 0,0 0,3190

Target lesion(s)

Iliac vessels 16 16,3 4 8,3 0,1870

Superficial femoral artery 76 77,6 44 91,7 0,0362

Below the knee 23 23,5 11 22,9 0,9408

Lesion characteristics

Length of occlusion (cm) >10 26 26,5 9 18,8 0,3009

Results

1) Primary revascularization success

No DM DM0

20

40

60

80

100

Perc

en

tag

e (

%)

ns

p = 0,7338

Results

2) Periprocedural complications

No Diabetes mellitus Diabetes mellitus p-value

absolut % absolut %

146 98 67,1 48 32,9

Major bleeding 3 3,1 2 4,2 0,7301

Aneurysma sp. 3 3,1 1 2,1 0,7338

AV-fistula 1 1,0 0 0,0 0,4825

Compartment syndrome 0 0,0 0 0,0

Results

3) 1 year patency

0 100 200 300 3650

20

40

60

80

100

Days elapsed

Perc

en

tag

e (

%)

No DM

DM

p = 0,1601

Results

4) Survival

0 100 200 300 3650

20

40

60

80

100

Days elapsed

Perc

en

tag

e (

%)

Survival

No DM

DM

p = 0,0787

0 100 200 300 3650

20

40

60

80

100

Days elapsed

Perc

en

tag

e (

%)

Event free survival

No DM

DM

p = 0,1007

Limitations

• Group size

• Retrospective

• Loss to follow up

Conclusion

For (sub)acute limb ischemia, rotationalthrombectomy (Rotarex©) is a safe and effectivetechnique in patients with and without diabetes

mellitus.

Thank you!

... and hope to see you soon in Heidelberg!

Further characteristics

No Diabetes mellitus Diabetes mellitus p-value

absolut % absolut %

146 98 67,1 48 32,9

Acute ischemia 6 6,1 4 8,3 0,6193

Critical ischemia 7 7,1 5 10,4 0,4987

Stent 56 57,1 25 52,1 0,5634

DCB 47 48,0 27 56,3 0,3466

Loss to follow up (1 year) 25 22,5 10 20,8 0,5341

Lesion characteristics

No Diabetes mellitus Diabetes mellitus p-value

absolut % absolut %

146 98 67,1 48 32,9

Major lesion

Native vessel 67 76,1 33 68,8 0,3508

Bypass 2 2,0 0 0,0 0,3190

Target lesion(s)

Iliacal vessels 16 16,3 4 8,3 0,1870

Superficial femoral artery 76 77,6 44 91,7 0,0362

Below the knee 23 23,5 11 22,9 0,9408

Lesion characteristics

Thrombotic burden low 33 33,7 17 35,4 0,8348

moderate-severe 65 66,3 31 64,6

Length of occlusion (cm) >10 26 26,5 9 18,8 0,3009

Lesion characteristicsNo Diabetes mellitus Diabetes mellitus p-value

absolut % absolut %

146 98 67,1 48 32,9

Rutherford 3 68 69,4 27 56,0

0,1212

4 22 22,2 10 20,8

5 3 3,1 5 10,4

6 2 2,0 4 8,3

n.a. 3 3,0 2 4,2

Major lesion

Native vessel 67 76,1 33 68,8 0,3508

Bypass 2 2,0 0 0,0 0,3190

Target lesion(s)

Iliacal 16 16,3 4 8,3 0,1870

Superficial femoral artery 76 77,6 44 91,7 0,0362

Below the knee 23 23,5 11 22,9 0,9408

Lesion characteristics

Length of occlusion (cm) >10 26 26,5 9 18,80,3009

Rotational thombectomy (Rotarex©) for(sub)acute limb ischemia – a safe approach

also in patients with diabetes mellitus?

M. Dufner, M. Kronlage, I. Printz, B. Heilmeier, E. Blessing, O. Müller, H. Katus, C. Erbel

Matthias Dufner

University Hospital Heidelberg, Germany