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At least 217 records · Page 12Linked to original sources
PubMed1997

[Role of pulse spray thrombolysis in acute ischemia of the extremities--comparison of results with the low dose technique of local thrombolysis, embolectomy and thrombectomy].

BACKGROUND: The reported mortality of patients suffering from acute limb ischemia is in the range of 10% to 30%, as is the incidence of amputation in the survivors. MAIN PURPOSE: The evaluation of the pulse spray thrombolysis (PST) role in the treatment of acute extremity ischemia originating from thrombosis or embolism of native artery or bypass graft. The comparison of PST with low dose technique thrombolysis (LD), thrombectomy (TE) and embolectomy (EE). METHODS: Ninety nine consecutive patients were evaluated during a two year interval (1994-1996). PST, resp. LD, TE and EE were the method of choice in 22, resp. 11, 35 and 31 patients of average age 58.3 +/- 13.7; resp. 60.0 +/- 8.9; 74.2 +/- 11.7; 76.9 +/- 9.3 years. The native artery was occluded in 15 (68.2%), resp. 8 (72.7%), 31 (88.6%) and 30 (96.8%) patients with PST, resp. LD, TE and EE treatment. The vascular reconstruction was occluded in the rest of the cases. The lower limb extremity arteries were occluded in 20 (90.9%) of patients indicated for PST, 10 (90.9%) for LD, 33 (94.3%) for TE and 26 (83.9%) for EE. The contraindication for local fibrinolysis was severely ischemic limb in which viability was imminently threatened. RESULTS: PST was successful in 19 (86.4%), LD in seven (63.4%), TE in 13 (37.1) and EE in 27 (87.1%) patients. The failure of procedure required amputation in one patient (4.5%) with PST, one (9.1%) with LD, nine (25.7%) with TE-p < 0.001 and two (6.5%) with EE. The mortality was 4.5% (one patient), resp. 0%, 28.6% (10 patients)-p < 0.001 and 3.2% (one patient) in PST, resp. LD, TE and EE. The long term results were better if the successful local fibrinolysis was combined with percutaneous transluminal angioplasty (PTA), stent implantation or small vascular reconstruction. CONCLUSION: PST is the method of choice in the treatment of thrombotic or embolic occlusion of native artery or bypass graft in condition of good limb viability where there is no danger of time delay. EE is indicated in limb embolism where the viability of extremity is threatened. Thrombectomy alone has no place in the treatment of artery or bypass graft thrombosis.

Embolectomy↗
PubMed1983

A technical aid for the difficult embolectomy.

Occasionally an embolectomy cannot be performed because of failure of the catheter to pass beyond the embolus. We employ a technique that overcomes this problem when it is due to a holdup of the catheter in a branch orifice or atheromatous recess.

Catheterization↗
PubMed1985

Transvenous catheter pulmonary embolectomy.

Acute cardiovascular collapse in the hospitalized patient is associated with a high mortality rate and remains a therapeutic dilemma. Survival could be improved in the subgroup of patients with massive pulmonary thromboembolism if prompt surgical intervention is undertaken. This report presents the cases of two patients with cardiovascular collapse who survived transvenous catheter pulmonary embolectomy (herein described in detail). This procedure can be performed in any hospital with angiographic facilities and personnel trained in the technique. In our opinion it is the procedure of choice in patients with refractory cardiovascular collapse from massive pulmonary thromboembolism.

Catheterization↗
PubMed1976

Experimental middle cerebral artery microsurgical embolectomy.

The canine middle cerebral has been embolized using the method of Molinari. Microsurgical embolectomies were done at two hours and six hours post-embolism. Animals done at two hours remained virtually intact neurologically, and hence fared better than control dogs whose embolus remained in place. Animals done six hours post embolism had increased neurologic morbidity and mortality as compared to the controls. Pathologic study revealed hemorrhagic infarctions in 50% of the animals done six hours post embolism.

Animals↗
PubMed1984

[Embolectomy in patients with pulmonary embolism without symptoms of shock].

The therapeutic spectrum for the management of patients with pulmonary embolism includes either drug therapy with anticoagulants or with thrombolytic agents, or embolectomy. The indications for either form of therapy are not always clearly separable, but, in general, surgery is reserved for those patients with massive embolism and shock. Large, mobile thromboemboli located centrally, either within the right heart or in the main pulmonary artery, bear the risk of further, possibly fatal, embolisation that might actually be increased by thrombolytic therapy. Therefore, demonstration of such a thromboembolus seems to justify the decision for prompt surgical removal even in the absence of shock as exemplified in the two cases presented here.

Aged↗
PubMed1989

Anaesthetic management of emergency caesarean section followed by pulmonary embolectomy.

This report discusses the anaesthetic management of a patient undergoing emergency Caesarean section followed by an open pulmonary embolectomy with cardiopulmonary bypass. This case was complicated by the major physiological alterations associated with pregnancy and delivery, massive blood loss, cardiac dysrhythmias, hypotension, and cardiac arrest. Both patients, mother and child, made a full recovery.

Adult↗
PubMed1999

Bronchopleural fistula complicating group A beta-haemolytic streptococcal pneumonia. Use of a Fogarty embolectomy catheter for selective bronchial blockade.

A 36-year-old woman developed severe group A Streptococcal pneumonia, complicated by a bronchopleural fistula, ARDS and multi-organ failure. We describe the use of selective middle lobe bronchus blockade, with a Fogarty embolectomy catheter, to localise and control the air leak. This allowed effective mechanical ventilation and oxygenation on intensive care and during right middle lobectomy. The patient made a prolonged, but full recovery.

Adult↗
PubMed1991

Improved forceps for pulmonary embolectomy.

A malleable, nonocclusive forceps for surgical extraction of fresh pulmonary emboli is described. This device allows the performance of pulmonary embolectomy under direct vision with an unobscured peripheral field and reduces the potential for traumatic pulmonary artery laceration.

Equipment Design↗
PubMed1986

Emergent pulmonary embolectomy: the treatment for massive pulmonary embolus.

Massive pulmonary embolus usually leads to in-hospital mortality if not treated aggressively. Four patients were seen with severe cardiorespiratory compromise resulting from massive pulmonary emboli. Emergent pulmonary embolectomy was followed by marked clinical improvement, and 3 patients were subsequently discharged from the hospital. The clinical courses of these patients are described, and massive pulmonary embolus and its management are discussed.

Acute Disease↗
PubMed1978

Vena cava interruption after pulmonary embolectomy.

Interruption of the inferior vena cava for thromboembolism is occasionally apppropriate following either pulmonary embolectomy or other cardiac operation performed through a median sternotomy. Experience has shown that simple extension of the sternotomy incision to the umbilicus is a quick and practical means of obtaining good exposure for caval interruption.

Abdominal Muscles↗
PubMed1996

Long-term follow-up in pulmonary embolectomy: is NYHA (dyspnea) classification reliable?

In this retrospective investigation we carried out a thorough physical examination, ventilation/perfusion scintigraphy, echocardiography and lung function test in 19 of all 21 long-term survivors consecutively operated on for massive pulmonary embolism between 1968 and 1992. Two patients refused these investigations but were both asymptomatic. The mean follow-up was 8.4 years and 12 (57%) of the patients were in NYHA I and 6 (29%) in NYHA II. The three patients in NYHA III (there were none in class IV) underwent right heart catheterization and pulmonary angiography additionally. Our findings suggest that, generally, the results of scintigraphy, echocardiography, lung function tests and physical examination correspond to the subjective status expressed as NYHA (dyspnea) class, when evaluated in combination. However, in classes III and IV other causes of dyspnea apart from residual pulmonary vascular obstruction can be found. These may also occur in combination. We observed severe chronic obstructive lung disease, hemidiaphragmatic paralysis, obesity, pulmonary hypertension of unknown origin, atrial septal defect (ASD) and neurologic residual deficit with depressive state. Thus, in evaluating long-term results of pulmonary embolectomy with regard to vascular desobliteration, NYHA classification does not seem to be reliable for classes III and IV.

Adult↗
PubMed1978

[Correction of left coronary artery to pulmonary artery fistula on the occasion of pulmonary embolectomy (author's transl)].

In a 42 year old woman a left coronary artery to pulmonary artery fistula was proved by catheterization and coronary angiography. During this investigations a right femoral hernia became symptomatic, and surgical correction was carried out. Three days postoperatively a massive pulmonary embolism occurred causing shock and fibrillation of the heart. After intubation the patient was brought to the operating theatre under external massage, and a pulmonary embolectomy using ECC was performed. The fistula in the main pulmonary artery was closed by suture. The vascular convolute was left in place. A primarily additional ligature of the fistula artery at the starting point was reopened because of a failing right ventricle under the assumption of a possible partial vascular supply of the right ventricular myocardium which could not be proved.

Adult↗
PubMed1975

[The tourniquet-syndrome--a severe complication after embolectomy of saddle embolism (author's transl)].

The symptoms of the tourniquet syndrome (hypotonia, tachycardia, postischemic edema, hypercaliemia, metabolic acidosis, myoglobinuria, renal insufficiency) could be observed after embolectomy of saddle embolism in 37 patients. 19 patients died postoperatively; heart insufficiency was demonstrated by autopsy in 14 patients. The pathophysiology of heart failure in tourniquet syndrome was studied in dog experiments after unilateral and bilateral hind limb ischemia. The development of shock turned out to be more severe after bilateral ischemia--comparable to saddle embolism--than after unilateral ischemia. The course of heart failure after recirculation could be referred to hypercaliemia, hypermagnesiemia, metabolic acidosis and hemoconcentration. The prophylaxis of the tourniquet syndrome can be practised by knowing the pathogenesis.

Acid-Base Equilibrium↗
PubMed1999

Inhalation of nitric oxide as a life-saving therapy in a patient after pulmonary embolectomy.

We describe a 54-yr-old man with cardiogenic shock caused by acute right heart failure after pulmonary embolectomy. Inhalation of nitric oxide led to immediate improvement in respiratory and haemodynamic variables. Inhaled nitric oxide can be used to reduce acute right heart failure until conventional therapy can provide successful haemodynamic stability.

Administration, Inhalation↗
PubMed1984

Arterial embolectomy: a review of 100 cases.

The results of 100 consecutive patients undergoing arterial embolectomy at the Royal Brisbane Hospital between 1971 and 1981 are presented. Twenty-two patients died and 18 of these had unsuccessful procedures. Of the 82 patients surviving more than 30 days, 14 had a limb amputated and 12 underwent further vascular surgery. Duration of ischaemia was the most important predictive factor; 75% of cases with an ischaemia time of less than 12 h had a successful outcome whereas only 37% were successful when the ischaemia time exceeded 12 h. Anticoagulation improved the success rate, but resulted in a high incidence of wound haematoma.

Acute Disease↗
PubMed1976

Repair in arterial tissue. Electron microscopy of Evans blue vital stained embolectomy catheter lesion of the rabbit thoracic aorta.

The rabbit thoracic aorta was studied by EM and vital staining with Evans blue at vaired points of time after a single lesion produced by an embolectomy catheter. EM of white areas: the surface cells of the myo-intimal thickening resembled endothelial cells with a discrete occurrence of microfilaments inside the plasma-membranes and rather differentiated flap-like junctions. EM of blue areas: the surface cells resembled modified smooth muscle cells with a heavily contrasted zone just inside the luminal plasma membrane containing closely packed microfilaments. The cell contacts either were missing, or they presented undifferentiated side-to-side contacts.

Animals↗