Thrombectomy
Feline aortic thromboembolism (FATE) is a painful, debilitating, and life-threatening syndrome encountered most commonly in cats with underlying heart disease in which a thrombus develops in the left atrium and embolizes to the aortic trifurcation resulting in varying degrees of hind limb paresis/paralysis and shock. Approximately 50% of cats are in congestive heart failure at the time of diagnosis making them poor candidates for invasive surgical thrombectomy. Unfortunately, thrombolytic therapy with streptokinase or TPA has failed to improve the approximately 50% survival rate associated with conservative management but can result in faster return of hind limb pulses and perhaps less discomfort. Recently, using interventional techniques, rheolytic thrombectomy has been described which achieved successful thrombectomy in 5/6 cats reported.3 While overall mortality rates were not dramatically improved compared to conservative management, this technique demonstrates the ability to rapidly and successfully remove thrombi and restore perfusion in some of the smallest and most debilitated veterinary patients. The dramatic arteriographic improvement provides hope that as the technique is refined, improved clinical outcomes will follow. (Figure 2)
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Figure 2. Digital subtraction aortograms of a cat with FATE pre- and post-rheolytic thrombectomy. (Pre-Thrombectomy) DSA demonstrating complete distal aortic trifurcation occlusion. (Post-Thrombectomy) DSA demonstrating restored perfusion to distal aorta, external iliac (EIA), internal iliac (IIA) and median sacral arteries.
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