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PubMedDate not supplied

Arterial embolectomies in the upper extremity after acute occlusion. Report on 79 cases.

Between 1970 and 1981 a total of 79 surgical interventions were performed for acute ischemia of the upper extremities. The cause of occlusion in 70 patients was an arterial embolism, mainly affecting the brachial or radial artery. Embolectomy was successful in restoring the patency of the occluded vessel, regardless of its location or the duration of the occlusion. In 8 patients the cause of occlusion was an arterial thrombosis. The results after surgery varied, in 4 patients an amputation was necessary whilst 2 patients underwent successful bypass operations. One patient had angiospasm after osteosynthesis of a humerus fracture. The mean age was 67 years, the hospital mortality amounted to 12%. After embolectomy, the function and pulse condition of the treated extremity was excellent in the 51 patients still alive.

Adolescent↗
PubMed1982

Arterial embolectomy in the modern era.

The introduction of the Fogarty catheter heralded a new era in the management of patients with arterial embolism. In the 15 years from 1966 to 1980, the authors managed, operatively, 148 separate episodes of arterial embolization in 134 patients. Excluded from the series were patients who had visceral emboli and those who were managed nonoperatively. The emboli occurred in the upper extremities in 22 patients who had 24 embolic episodes and in the lower extremities in 112 patients who had 124 separate embolic episodes. The source of the embolus was the heart in 106 patients and in the remaining 28 patients a proximal aneurysm or atherosclerotic artery, a prosthetic graft or an unknown source. Most operative procedures were performed under local anesthesia using a transverse arteriotomy. The limb was saved in all 24 episodes of upper extremity embolism and in 115 (87%) of 132 lower limbs at risk (seven patients had emboli in both lower extremities simultaneously and one had emboli in an upper extremity and lower extremity simultaneously). The mortality for the 148 embolectomies was 20% an included all deaths occurring within 30 days after operation or during the same hospital admission. An analysis of our results indicates that embolectomy may not be successful when the delay between the occurrence of the embolus and its removal is excessively prolonged (more than 48 hours), when the patient is elderly and when the source of the embolus is unknown.

Adult↗
PubMed1977

Analysis of factors affecting limb salvage and mortality after embolectomy.

A series of 108 arterial embolectomies in 91 patients performed during 1960-64 and 1970-74 is presented. The Fogarty catheter was introduced in our clinic between these periods. Early mortality was 56 and 29%, respectively. Limb salvage rate according to our definition was 38 and 53%, respectively. We found a significantly higher mortality when embolies were located proximal to the profunda femoral artery compared to more distally located embolies. Amputation frequency was 4% after embolectomies performed within 12 hours, but 27% with longer duration of symptoms. Limb salvage rate was significantly higher in patients treated with anticoagulation. In conclusion it is stressed that local surgical therapy should be combined with adequate measures against cardiac failure and other systemic complications. This therapeutic principle is particularly important in cases with proximal embolies.

Aged↗
PubMed1981

Pulmonary embolectomy re-evaluated.

Forty-two patients who had sustained massive pulmonary embolism were treated by emergency pulmonary embolectomy using normothermic venous inflow occlusion circulatory arrest. Of 26 patients who had not had cardiac arrest before surgery 25 survived the operation, but 7 later died from various causes. Only 1 of 16 patients who had sustained cardiac arrest survived. In all, 19 patients (45.2%) left hospital alive. This simple and widely applicable technique has enabled an emergency pulmonary embolectomy service to be offered to all the hospitals in a metropolitan area.

Cardiopulmonary Bypass↗
PubMed1978

[Successful embolectomy of the superior mesenteric artery].

Successful embolectomy of the superior mesenteric artery in a 75-year-old man is reported. The decisive points in early diagnosis are discussed and the specific diagnostic methods for the correct decision are presented. The fulminant evolution of the disease leaves little time in which to decide. Early embolectomy brings about complete cure. It is a life-saving operation and there are no contraindications.

Aged↗
PubMed1999

[Surgical embolectomy after reanimation in central pulmonary embolism].

Central pulmonary embolism represents one of the most threatening complications in surgical patients. In most cases deep vein thrombosis of the lower extremities is the source of emboli. Despite the introduction of hypocoagulative drugs in standard surgical concepts the incidence of deep vein thrombosis remains about 10% in trauma patients. Estimated numbers of unknown cases of pulmonary embolism are supposed to be rather high too. In haemodynamically symptomatic pulmonary embolism events and especially when the patient has to be reanimated, mortality rates of up to 93% are reported in literature. After introduction of the heart- and lung-machine in the surgical concept of therapy, survival rates have increased significantly. We report on three cases of successful surgical embolectomy after CPR. In a review of literature current concepts of treatment in central pulmonary embolism are discussed.

Acetabulum↗
PubMed2006

Off-pump open pulmonary embolectomy for major bilateral pulmonary emboli: report of a case.

Acute massive or submassive pulmonary artery thromboembolism causes sudden hemodynamic deterioration, warranting immediate surgery. We report the case of a 67-year-old woman who suffered a syncopal attack resulting in shock, 3 weeks after undergoing orthopedic surgery. Preoperative radiologic imaging studies, including a lung perfusion scan, chest scan, and venography, showed a major bilateral pulmonary artery embolism (PE) originating from a leg vein. An inferior vena cava filter was inserted preoperatively during the venography. We performed an open pulmonary embolectomy without cardiopulmonary bypass by using a submammary trans-sternal bilateral thoracotomy approach. The patient recovered uneventfully and has been well for 13 months.

Aged↗
PubMed2006

Arterial embolectomy: a retrospective evaluation of 730 cases over 20 years.

PURPOSE: We reviewed our experience of treating acute peripheral arterial occlusion to determine whether early diagnosis and treatment prevents loss of function of the vital organs caused by ischemia threatening the extremities. METHODS: We retrospectively examined the records of 730 patients who underwent a collective total of 794 operations for peripheral arterial occlusion of the upper or lower extremities at Erzurum Numune Hospital between January 1984 and April 2004. RESULTS: The patients ranged in age from 11 to 86 years old, with a mean age of 58.7 years for men and 64.3 years for women. The underlying cause of arterial embolism was atrial fibrillation in most (433; 59.3%) patients. Two hundred and eleven (28.9%) patients were admitted less than 6 h preoperatively, 104 (14.2%) were admitted 6-12 h preoperatively, 194 (26.5%) were admitted 12-24 h preoperatively, and 221 (30.2%) were admitted more than 24 h preoperatively. All of the patients underwent embolectomy and 64 revisions were done. The overall mortality rate was 3.69%. CONCLUSIONS: The extremity preservation rate was related to the time delay between the onset of symptoms and surgical intervention.

Adolescent↗
PubMed1999

Shredding embolectomy thrombectomy catheter for treatment of acute lower-limb ischemia.

We undertook a prospective evaluation to prove a new mechanical thrombectomy device, the shredding embolectomy thrombectomy catheter (S.E.T. catheter), for the treatment of patients with acute lower-limb ischemia. The study evaluated the success, patency, mortality, limb salvage, and complication rates for 51 patients treated from January 1994 through June 1996, with this device, which was an 8-F three-lumen catheter. The onset of symptoms was 8.6 +/- 9 days. Thrombus length was 18 +/- 9 cm situated in 44 native vessels and in 7 bypasses, 42 limbs were graded as threatened. Hydromechanical thrombectomy with the S.E.T. catheter proved to be a quick and safe adjunct for therapy of acute femoropopliteal thromboembolic occlusions with a high initial success rate and an acceptable mid-term patency rate.

Acute Disease↗
PubMed1995

Electron beam computed tomography: use in pulmonary embolectomy.

Proximal chronic pulmonary emboli with severe pulmonary hypertension were diagnosed by electron-beam computed tomography and Doppler echocardiography. After successful embolectomy, repeat examinations showed normal pulmonary artery pressures and patency. Electron beam computed tomography can noninvasively identify surgically treatable pulmonary emboli.

Adult↗
PubMed1995

Retrograde pulmonary embolectomy by flushing of the pulmonary veins.

A glue embolization of a cerebral arteriovenous malformation in a 3-year-old boy was complicated by a massive pulmonary embolus due to glue entering the venous circulation. Attempted pulmonary embolectomy via pulmonary arteriotomy after emergency cardiopulmonary bypass was unsuccessful. However, retrograde flushing of the pulmonary veins with cold saline solution produced large quantities of embolus through the pulmonary arteriotomy. Bypass was discontinued uneventfully with no residual cardiopulmonary problems.

Cardiopulmonary Bypass↗
PubMed1996

Massive endobronchial hemorrhage after pulmonary embolectomy.

Massive endobronchial hemorrhage is a lethal complication in pulmonary embolectomy. We report a case of massive endobronchial hemorrhage occurring after successful restoration of pulmonary blood flow using cardiopulmonary bypass in a patient with pulmonary embolism. Two possible causative factors of this complication are described.

Adult↗
PubMed2005

Mechanical embolectomy.

Mechanical embolectomy in acute ischemic stroke employs the use of novel endovascular devices to revascularize occluded intracerebral arteries. Devices like the Merci Retiever and other endovascular snares, laser thrombectomy and rheolytic/obliterative microcatheters, intracranial balloon angioplasty and stenting, and intra-arterial and transcranial ultrasound-enhanced chemical thrombolysis are intended to improve tissue rescue and diminish reperfusion hemorrhage while broadening the population eligible for therapy. Patient selection with MRI- and CT-based stroke protocols can detect tissue at risk and may obviate the classic limitations of the stroke therapeutic time window. These devices are being developed and modified at a rapid pace, requiring mounting endovascular expertise, and are being used successfully alone or in conjunction with chemical thrombolysis with relative safety.

Brain Ischemia↗
PubMed2003

Minimally invasive off-pump pulmonary embolectomy.

We report the case of a 35-year-old female with acute massive right pulmonary embolism, successfully treated by a minimally invasive off-pump pulmonary embolectomy-the first case in the literature implemented via the J-ministernotomy.

Adult↗
PubMed2001

Emergency surgical pulmonary embolectomy.

Emergency surgical pulmonary embolectomy is a highly effective treatment for selected patients with pulmonary embolism. Rapid noninvasive diagnostic modalities allow proper patient selection based on anatomic location of the emboli, right heart function, and contraindications to thrombolysis. Operative results are a direct reflection of the preoperative hemodynamic status, the degree of underlying cardiopulmonary disease, and attention to minimizing surgical trauma and protecting the right heart. An operative mortality of 10% or less and excellent long-term outcomes can be expected if the procedure is performed prior to cardiovascular collapse as part of a multidisciplinary strategy which emphasizes careful patient selection, rapid diagnosis, triage, and transport.

Embolectomy↗
PubMed1992

[Percutaneous aspiration embolectomy of the popliteal artery].

Twenty-eight patients (17 women, 11 men, average age 67 years, range 40-85 years) with embolic occlusions of the popliteal arteries were treated by aspiration embolectomy. 6 patients were in clinical stage IIb and 22 in stage III. In 25 of the 28 patients the occlusion was treated successfully. Complications could be treated non-surgically at the same time. 2 of the patients died within the first week of cerebral emboli, 2 further patients suffered recurrent emboli in the treated extremity during the first month. 17 patients who were followed up for six months were free of recurrences.

Adult↗
PubMed1995

Tc-99m MAA lung perfusion scintigraphy performed before and after pulmonary embolectomy for saddle-type pulmonary embolism.

A 58-year-old man had shortness of breath, hypotension, and decreased partial pressure of oxygen (PO2) on the eighteenth day after undergoing craniotomy for a meningioma. Tc-99m MAA pulmonary perfusion scintigraphy showed little perfusion to the right lung and left lower lung and multiple perfusion defects in the left upper lung. Although the results of concurrent chest radiography were negative for pulmonary infiltrates, pulmonary angiography demonstrated a saddle-type embolism. The patient underwent emergency pulmonary artery embolectomy to remove blood clots and organized thromboemboli from the main pulmonary artery and the right and left pulmonary arteries. The patient's postoperative course was uneventful, and a second Tc-99m MAA lung perfusion scan demonstrated marked improvement in lung perfusion.

Embolectomy↗