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At least 649 records · Page 36Linked to original sources
PubMed1987

Patient survival and limb prognosis after arterial embolectomy.

Mortality and morbidity after arterial thromboembolectomy were studied in 202 patients. Factors affecting reoperation and survival were identified according to Cox's proportional hazards model. 30-day mortality was 26% and amputation rate 18.5%. NYHA classification was the most important predictor for survival; class 3-4 had a 3.35 times higher death rate than class 1-2. An age greater than 75 years increased the death rate by 2.35 times and the presence of ischaemic heart or peripheral arteriosclerotic disease increased it by 1.69 and 1.65 times, respectively. Symptoms less than or equal to 1 day in duration were associated with a death rate 1.53 times higher than for a longer duration. Reoperation rate was 2.15 times greater in the absence of atrial dysrhythmias. The amputation rate was 3.79 times higher in NYHA class 3-4 than in class 1-2, and 2.47 times higher in the presence of peripheral arteriosclerotic disease. Apparently, thrombosis rather than recurrent embolism is the most important cause of reoperation and amputation. The severity of pre-existing cardiopulmonary disease largely determines prognosis regardless of the severity of the superimposed acute occlusion.

Aged↗
PubMed1981

Pulmonary embolectomy using extracorporeal circulation.

Experience with 23 patients treated surgically, with the use of cardiopulmonary bypass, for massive pulmonary embolism is presented. Seventy-four percent survived surgery. Of the survivors all but 3 were fully recovered after observation times ranging from 3 months up to 7 years. The patient category presents the basis for our contemporary indications for surgery, i.e. patients in fulminant shock, in deteriorating clinical conditions or with contraindications for thrombolysis. In these patients surgical intervention is recommended with the use of the heart lung machine.

Adult↗
PubMed1989

Fibrinolytic treatment of residual thrombus after catheter embolectomy for severe lower limb ischemia.

Intraoperative intraarterial fibrinolytic therapy (IIFT) was employed in 28 patients with acute limb ischemia. In 17 patients, significant residual calf thrombus was demonstrated by completion arteriography after standard balloon catheter thromboembolectomy, whereas in 11, pretreatment arteriography was not obtained. With the patient systemically heparinized, a bolus of fibrinolytic agent was instilled into the distal vessels below an inflow occlusion clamp. Among the 17 patients under angiographic control, arteriography was repeated after 30 minutes and a second bolus was injected if significant residual thrombus was still present. Successful lysis was achieved in 88% of these 17 limbs and streptokinase (SK) and urokinase (UK) were equally effective. The dosage of SK varied between 50,000 and 150,000 units (seven patients) and of UK between 35,000 and 150,000 units (21 patients). Serum fibrinogen levels declined significantly after IIFT (t test; p less than 0.05), but the average level remained within the normal range. Major bleeding developed in two patients, both of whom received SK and underwent a concomitant major abdominal vascular procedure, with a severe fall in fibrinogen values to 10 and 17 mg/dl. A minor groin hematoma occurred in one patient treated with UK. There was a significant difference in the incidence of bleeding between SK (2/7) and UK (1/21) (chi 2; p less than 0.05). Compartment syndrome developed in six limbs (21%). Amputation was required in two patients (7%). There was no correlation between prolongation of ischemia time as a result of IIFT and the incidence of compartment syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization↗