# Case series report on long-term result of endovascular approach to thrombosed limb or limb graft occlusion of aortoiliac endoprosthetic stent graft using the first-order percutaneous mechanical arterial advanced thrombectomy technology protocol

## TL;DR

This paper presents a case series showing the long-term success of a new minimally invasive technique for treating blocked grafts in aortoiliac stent grafts.

## Contribution

The paper introduces and validates the FOPMAATT protocol as a novel, low-risk method for treating limb graft occlusion.

## Key findings

- Five patients treated with FOPMAATT had no significant postoperative complications.
- No blood transfusions or extended hospital stays were required in the reported cases.
- The technique avoided the use of thrombolytic drugs, reducing bleeding risks.

## Abstract

To address the limitations of conventional management of limb graft occlusion after endovascular aortic aneurysm repair and endoprosthetic stent graft placement for aortoiliac occlusive disease, our team pioneered an innovative technique known as first-order percutaneous mechanical arterial advanced thrombectomy technology (FOPMAATT). We previously reported a single case where the benefits of the technique were demonstrated in 2022 by Willhite et al. The case report described the use of the FOPMAATT protocol in a patient with limb graft occlusion after EVAR endoprosthetic stent graft implantation for abdominal aortic aneurysm endovascular repair. In this consecutive case series, five patients underwent the FOPMAATT protocol procedure, resulting in positive patient outcomes such as a low postoperative complication rate. Each patient was followed for ≥2 years to assess long-term outcomes. Of the five cases reported, we did not observe a significant adverse perioperative event, no blood loss significant enough to require transfusion, or length of stay of >1 day owing to any surgical cause. Additionally, we did not use adjuvant pharmacological thrombolytic therapy in the FOPMAATT protocol, which may decrease the risk of perioperative bleeding.