Patient Presentation

A man in his late 50s presented to the emergency department with 4 weeks of acute-onset, severely limiting short distance claudication in his right lower extremity.

Diagnostic Findings

A CTA showed a popliteal artery occlusion, confirmed by a follow-up angiogram that showed minimal distal reconstitution (Figure 1A).

Figure 1. Preprocedure angiogram (A) and follow-up angiograms after four separate passes with the Pounce™ Thrombectomy System: two passes in the PT artery (B), one pass in the AT artery (C), and one pass in the peroneal artery (D).

Treatment

Left femoral access was obtained and a 7 Fr Destination™ Peripheral Guiding Sheath (Terumo Interventional Systems) was delivered up and over into the right femoral artery. A .035 guidewire crossed the lesion easily, indicating thrombus present. The Pounce™ Thrombectomy System* (Surmodics, Inc.) was introduced with the baskets initially deployed distal to the occlusion in the proximal posterior tibial (PT) artery and the funnel deployed proximal to the occlusion in the superficial femoral artery (SFA)/popliteal junction. Four passes were performed: two in the PT artery (Figure 1B), one in the anterior tibial (AT) artery (Figure 1C), and one in the peroneal artery (Figure 1D). A final angiogram demonstrated restored flow to all tibial vessels with no signs of residual clots or embolization (Figure 1D).

Postprocedure Outcome

The patient was hospitalized for 2 days after the intervention for medical monitoring of a mechanical atrioventricular valve. The Pounce™ Thrombectomy System enabled removal of infrapopliteal and tibial thrombus and flow restoration below the knee with no signs of residual thrombus or embolization.

*The indicated vessel range for the Pounce™ Thrombectomy System is 3.5-6 mm.

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.

Charles DeCarlo, MD
Vascular Surgeon
Hackensack Meridian Health
Hackensack, New Jersey
Disclosures: Consultant to Surmodics.