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PubMed1984

Percutaneous embolectomy by transcatheter aspiration. Work in progress.

Distal embolization occurred in 14 of 339 (4%) attempted percutaneous transluminal angioplasty (PTA) procedures, including five of 225 stenoses (2.2%) and nine of the 81 occlusions (11%) that were crossed successfully in 114 attempts (8%). Transcatheter embolectomy by aspiration through a nontapered large-bore catheter was technically successful in five of six attempts (83%), and was combined with successful PTA in three of five patients. In two patients in whom the clinical result of PTA was considered unsatisfactory, successful transcatheter embolectomy permitted an uncomplicated surgical by-pass procedure to be performed. If clinically significant embolization occurs during PTA, this procedure can be attempted prior to surgical embolectomy as an alternative to local fibrinolytic therapy.

Aged↗
PubMed1992

Percutaneous embolectomy: in vitro investigations of the self-expanding tulip sheath.

A self-expanding sheath with a tulip-shaped distal end was designed for performance of percutaneous embolectomy. Its ability to retrieve clots was tested in an in vitro flow model; results were compared with those obtained with a conventional 10-F sheath. Simulated embolectomy of clots weighing 0.1-1.5 g was performed with a 0.75-mL Fogarty balloon on a 4-F catheter. The clot material that embolized distally during the procedure was sampled and quantified. No effective embolectomy was performed via a conventional sheath. With the tulip sheath, however, complete clot removal was achieved unless the clot size exceeded the tulip volume. On the basis of results of in vitro testing, the tulip design is promising for use in several applications during percutaneous interventions.

Catheterization↗
PubMed1995

Percutaneous balloon embolectomy with a self-expanding tulip sheath: in vivo experiments.

PURPOSE: To test a self-expanding tulip-shaped sheath designed for percutaneous embolectomy in an in vivo animal experiment. MATERIALS AND METHODS: In nine sheep, a total of 23 percutaneous balloon embolectomies were performed with use of a self-expanding tulip sheath device with an outer diameter of 9- or 10-F when collapsed. A 10-F instrument was used in 11 cases, and a 9-F instrument was used in 12. Radiopaque emboli were pushed into the aorta via the left carotid or contralateral femoral artery with a 16-F introducer sheath. RESULTS: The embolus was captured in the tulip cage in all 23 cases. Retrieval of the embolus into the sheath was complete in 21 of 23 cases. In two cases, minor parts of the embolus dislodged from the sheath. Major embolism did not occur. In nine cases, the outer sheath had to be cleared of remaining clot particles with aspiration. CONCLUSION: The noncovered self-expanding tulip sheath is an effective and safe instrument for percutaneous embolectomy under in vivo conditions.

Animals↗
PubMedDate not supplied

Complications encountered during arterial embolectomy with the Fogarty balloon catheter.

The Fogarty arterial embolectomy catheter, while indispensible in the armamentarium of the vascular surgeon, is not entirely benign instrument. A case is desribed in which the balloon was lost in its entirety from the catheter and immediately retrieved using a second identical instrument. A comprehensive survey of the literature reveals that a variety of arterial injuries have occurred during the use of the Fogarty catheter. Each of the major ones is discussed in depth. Amongst the most serious are arterial perforation and rupture occasionally followed by loss of the involved extremity. All previously reported complications following use of the Fogarty catheter are tabulated and reviewed. Additionally, a formal classification of these complications is proposed. Since the time of its introduction in 1963 the Fogarty ballon-tipped catheter has become an indispensible tool in the armamentarium of the vascular surgeon. Its use for arterial embolectomy has been responsible for the salvage of many thousands of limbs. Over the course of the past decade, however, a number of complications referable to this instrument have appeared in the literature. These include perforation of vessels, intimal disruption and foreign body embolization amongst others. To our knowledge, however, there has been only one reported case of a balloon having been lost intra-arterially in toto without obvious cause. It is the purpose of this paper to present the second such case where the balloon, which had separated entirely from the catheter during the course of an arterial embolectomy, was later retrieved by passage of a second Fogarty catheter. In addition, a comprehensive review of the literature is undertaken, and all arterial complications reported to date summarized and tabulated.

Aneurysm↗
PubMedDate not supplied

Arterial embolectomy in lower limbs.

Arterial embolisms in the lower limbs occur frequently, and are of great interest to the vascular surgeon. The authors studied 159 cases of arterial embolisms in lower limbs from January 1991 to July 1993. Ages varied from 12 to 98, with a mean of 58. Eighty patients were male and 78 were female. In most cases, etiology of the embolus was well-established, and mainly caused (78 percent) by atrial fibrillation. Occlusion was most frequent in the femoral artery (53.4 percent). All patients presented severe lower limb ischemia, but not gangrene, on admission. The duration of ischemia, between the onset of symptoms and the liberation of arterial flow, was in most patients (67.9 percent) less than 24 hours. All patients were submitted to lower limb embolectomy with the Fogarty catheter, of which 70.9 percent were done through the femoral artery. Fasciotomy was performed on 48 patients due to a compartimental syndrome. Nineteen patients died immediately after operation; 68.4 percent due to heart failure. Twenty-three (16.4 percent) of the 140 surviving patients (150 operated limbs) were submitted to amputations after the occlusion of artery branches, which had undergone embolectomies. One hundred and twenty-seven limbs (84.6 percent) were preserved in 117 patients (83.5 percent). Eleven cases (7.3 percent) required repeated surgery with the Fogarty catheter. The patients with muscle tenderness, paralysis, or ischemia lasting longer than 24 hours had worse results in relation to the preservation of the limb (p < 0.05). We conclude that patients who present lower limb embolisms, are in good clinical condition, and who do not have any necrosis in the limbs, have good outcomes as to limb preservation, along with low complication rates, after embolectomy with the Fogarty catheter. Limb preservation was significantly higher in patients who did not present muscle tenderness, and who had normal motor activity and a ischemia duration of less than 24 hours.

Adolescent↗
PubMed1989

Emergency embolectomy in a patient with massive pulmonary embolism during second trimester pregnancy.

Emergency pulmonary embolectomy was performed successfully on a patient in her second trimester of pregnancy. The patient had severe right ventricular failure due to obstruction of 85% of the pulmonary arterial circulation. Three months after embolectomy she was delivered of a normal infant. The problem of significant but misinterpreted or overlooked clinical and electrocardiographic signs of pulmonary embolism is discussed. Thrombolytic therapy during pregnancy imposes considerable risk of bleeding with deleterious effects on both mother and fetus. In our opinion, emergency embolectomy during extracorporeal circulation is the best treatment in case of massive emboli during pregnancy.

Adult↗
PubMed1975

Technical considerations in arterial embolectomy.

The frequency of arterial embolism is high and seems to be increasing. The introduction of the Fogarty catheter for embolectomy has afforded a considerable simplification of the operative technique. Nevertheless the mortality and amputation rates are still substantially high. Early diagnosis and further improved technique for removal of the embolus may enhance limb salvage and reduce mortality rates. The present paper is a review of 10 years' experience concerning technical problems with embolectomy. The arteriotomy technique, the handling of the catheter, per- and postoperative management, and specific technical problems related to the embolic lodgement at different sites are discussed with the object of giving some hints on how to perform the embolectomy in a safe way and with best chances of a suscessful outcome.

Aorta↗
PubMedDate not supplied

Arterial embolectomy. A long-term perspective.

One hundred and thirteen elderly patients (median age 77 years, range 37-99) were followed up for 2-10.5 years after embolectomy in order to assess the late outcome. There were two groups of patients: those who had suffered an embolism (84) and those who in retrospect had thrombosis in situ (29). Thirty three of the embolus group (39%) died within 30 days of surgery, and factors associated with mortality (p less than 0.05) were age greater than 80 years, and failure to save the limb (17%). In the thrombosis group limb loss was more common (76%) and these patients also had a higher mortality (55%). Mean long term survival in the embolus group was 35 months (range 1-108 months) with a high mortality rate in the first 6 months after embolectomy and improved survival after this. There were no significant differences in mortality or cardiovascular events between the 27 patients on long term warfarin and the 19 patients not anticoagulated. Mortality after embolectomy is high but there remains a group of long term survivors. The value of oral anticoagulation for these patients remains unresolved.

Adult↗
PubMedDate not supplied

Pulmonary embolectomy (answered and unanswered questions).

Pulmonary embolectomy under total cardiopulmonary bypass was carried out in 16 patients with cardiogenic collapsus and hypotension not responding to vasopressors or cardiac arrest. Eleven patients (68.75%) survived and were followed up for years. Our observations are presented with special emphasis on the early and accurate diagnosis, the exact timing of the therapeutic methods, the use of the portable cardiopulmonary bypass-even in the ward, and the possibilities of decreasing the operative mortality rate in less than 30% (from 40% to 22% in our series). Despite the fact that in many countries, especially European, pulmonary artery embolectomy is no more carried out as a primary therapy for massive or submassive embolism since thrombolysis is today considered as the best therapy with a low mortality rate of 8-11%, we still believe that there is a number of patients who could benefit only from surgical intervention. Based on our own experience and that presented in the international literature, an attempt was made to discuss the existing problems, mainly diagnosis and treatment of this formidable condition, reevaluating pulmonary embolectomy.

Algorithms↗
PubMedDate not supplied

What is the place of pulmonary embolectomy today?

From 1.1970 to 31.12.1989, 134 patients with pulmonary embolism were treated by pulmonary embolectomy (74 women and 60 men) of mean age 55 years (23-78 years); 93 (69%) of these patients developed embolism during the postoperative period following surgery for another condition. In 12 cases the embolectomy was performed without circulatory assistance by a modified Trendelenburg operation after an average delay time of 2 hours. In 122 cases, extracorporeal circulation (ECC) was used, preceded in 64 cases, by a femoral-femoral bypass (the average delay interval of operation being 16.9 hours). At operation, 23 patients were in complete circulatory failure needing external cardiac massage, 34 were in cardiogenic shock with systolic arterial pressures (SAP) less than 60 mmHg, 42 maintained their arterial pressure between 60 and 100 mmHg, and only 35 were seen with SAP higher than 100 mmHg under vasopressive drugs. No haemodynamic and angiographic investigations could be undertaken in 31 patients because of their dramatic clinical state. In the other 103 patients who had invasive angiographic investigations performed the pulmonary bed was obstructed from 65% to 90% (mean 79.4%) according to Miller's index. The mean arterial pulmonary pressure was 51.2 mmHg. The survival rate at the 30th postoperative day showed 113 patients were alive (84.3%) with 7 among the 12 operated by the Trendelenburg's modified method and 106 among the 122 operated under ECC. The main causes of the 21 deaths were: peroperative 8, neurological 4, cardiac 4, respiratory 1, recurrent embolism 1, acute thrombosis of the IVC 1. Our results of pulmonary embolectomy can be compared favorably to those obtained by thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Surgical pulmonary embolectomy and thrombolytic therapy].

Acute, massive pulmonary embolism is life-threatening and must be treated immediately. Since the early 1970's when thrombolytic therapy was shown to hasten resolution of pulmonary emboli, there has been a debate in the literature as to new indications for surgical pulmonary embolectomy. Some authors believed that there are no longer any indications for embolectomy, while others justify surgery for certain indications. Although the debate is still on, this operation is very rarely performed today. We present a patient who developed massive pulmonary embolism, with continuing extreme hemodynamic and respiratory disturbances despite full thrombolytic treatment. Embolectomy was successfully performed.

Female↗
PubMed1990

[A case of chronic recurrent pulmonary embolism treated by pulmonary embolectomy and Günther vena caval filter implantation].

A case report of chronic recurrent pulmonary embolism treated by embolectomy and Günther vena caval filter. A 62-year-old man had suffered from dyspnea on effort for 4 years, and his feeling of dyspnea had gradually increased during the past 3 months. On the day of admission he was in a preshock state, and his pulmonary artery pressure was very high at 90/30 mmHg. Pulmonary blood perfusion scintigraphy showed multiple defects of isotope uptake. Immediately after the scintigraphy, pulmonary embolectomy was performed while using extracorporeal circulation. The operation was successful and his physical activity was markedly improved. After the operation, anti-coagulant and anti-platelet therapies were continued, but recurrence of pulmonary emboli was detected by scintigraphy, and some thrombi were found by venography in deep veins of the lower parts of both legs. To prevent recurrent pulmonary embolism, a Günther vena caval filter was inserted into the inferior vena cava. We considered this case as an acute worsening of chronic recurrent pulmonary embolism and we had the impression that pulmonary embolectomy is a very effective therapeutic method for serious pulmonary embolism, and that insertion of the Günther vena caval filter is a very easy and safe procedure.

Chronic Disease↗
PubMed1989

A case of acute superior mesenteric embolism successfully treated by embolectomy.

Superior mesenteric artery embolism is undoubtedly fatal unless operative intervention is promptly performed. The first case successfully managed by embolectomy in Taiwan is reported in this communication. The key to successful management lies in the early suspicion in patients with atrial fibrillation or recent myocardial infarction, presenting with sudden abdominal pain and an unremarkable physical examination. Abdominal angiography is strongly recommended; however, immediate laparatomy should not be postponed if angiography is not available. Early embolectomy is the only useful means of treatment to restore mesenteric circulation, preserve the bowel and rescue the patient. A 56-year-old woman was admitted with a 5-year history of rheumatic heart disease and atrial fibrillation. She had a sudden attack of severe abdominal pain 8 hours after cardiac catheterization. Abdominal examination was not remarkable and plain abdominal X-ray was negative, while bloody stools and leukocytosis developed 7 hours later. Superior mesenteric embolism was highly suspected and emergency laparotomy was performed. Successful embolectomy was carried out through the distal approach and the patient recovered completely without requiring small bowel resection. All branches of the superior mesenteric artery were demonstrated patent upon postoperative angiography.

Embolism↗
PubMed1989

[Acute arterial occlusion of the extremities. Rate of success following simple embolectomy and following combined procedures].

Acute arterial obstruction of the extremities represents the most common emergency in vascular surgery. Diagnosis is based on the typical history and clinical symptoms. Emboli in vessels without atherosclerotic changes can be removed by simple embolectomy. In atherosclerotic arteries or in cases of acute thrombotic occlusion preoperative angiography is recommended in order to perform extensive reconstructive procedures. 400 arterial reconstructions for acute obstruction of the extremities were analysed. 46 operations were done in the upper extremities. In the majority of the cases simple embolectomy was successful. Limb salvage was 100% although one embolectomy and one bypass procedure failed to restore full revascularization. Complication and mortality rate was low. 354 lower limbs were operated. 274 extremities could be saved (77.4%). Among 80 poor results 48 major amputations had to be done (13.5%). Perioperative mortality was 12.4%. Death was mainly attributed to myocardial infarction.

Acute Disease↗
PubMed1988

Tibial artery pseudoaneurysms: delayed complication of balloon catheter embolectomy.

Although complications of balloon catheter embolectomy are infrequent, the injury potential of these catheters is well recognized. This article describes a case of multiple tibial artery pseudoaneurysms that appeared 4 years after embolectomy in a 42-year-old man with otherwise normal arteries. The patient was treated by internal aneurysmorrhaphy without sequelae. A literature review of balloon catheter injuries yielded 46 cases categorized as arterial disruption (29), intimal injury (12), or catheter malfunction (5). These resulted in hemorrhage (13 cases), arteriovenous fistula (12), pseudoaneurysm (four), thrombosis (three), dissection (five), accelerated atherosclerosis (four), and catheter fragment embolism (five). Of these complications, only 41% were recognized during the initial operation. Direct observation detected 32% of these, whereas 68% were shown only by completion arteriography. Complications recognized during initial operation were more frequently asymptomatic without further surgery (84%) than those detected postoperatively (30%, p less than 0.001). Completion arteriography detected 87% of balloon catheter complications compared with only 23% of complications recognized intraoperatively without arteriography (p less than 0.001). We conclude that delicate technique, completion arteriography, prompt surgical treatment, and extended follow-up are important components of balloon catheter embolectomy.

Adult↗
PubMed1988

Ongoing role of pulmonary embolectomy.

Pulmonary embolism remains a frequent and often fatal disorder. For the majority of patients, anticoagulation with heparin followed by warfarin represents the primary mode of treatment. Thrombolytic therapy is recommended for the patient with massive pulmonary embolism that has produced hypotension. Embolectomy is reserved for the patient with post embolic systemic hypotension who has an absolute contraindication to thrombolysis or who deteriorates despite thrombolytic therapy. Following successful embolectomy the surgeon must treat the complications of the surgery and prevent recurrence. Complications include cerebral infarction, pulmonary infarction and endobronchial hemorrhage, right ventricular failure, local or systemic bleeding and venous stasis. A case of successful pulmonary embolectomy with a complicated postoperative course is presented and the pathophysiology and treatment of the complications are discussed.

Adrenal Gland Diseases↗
PubMed1988

Massive pulmonary embolism; the place for embolectomy.

Untreated massive pulmonary embolism is associated with a high mortality. Pulmonary embolectomy has been largely superceded by thrombolytic therapy, but there are cases in which pulmonary embolectomy remains the treatment of choice. We present three case reports and discuss the merits of the various treatments available for massive pulmonary embolism. The primary treatment of massive pulmonary embolism should be thrombolytic therapy, but for patients who are at risk of haemorrhage following surgery, who are in cardiogenic shock despite medical treatment, or fail to improve following cardiac arrest, then pulmonary embolectomy remains the treatment of choice.

Aged↗
PubMedDate not supplied

Lower limb embolectomy in old age.

The results of embolectomy in 56 patients, aged 80 years or more, with acute embolic lower limb ischemia are presented. An overall mortality rate of 32% is found. In patients with a simultaneous myocardial infarction the mortality rate was 100%. Of the surviving 38 patients 29 avoided amputation and were discharged with unchanged social and functional status. Bases on the present findings it is concluded, that embolectomy should always be tried, especially since it has been shown, that an unsuccessful embolectomy does not lead to an increased mortality if an eventual subsequent amputation has to be carried out.

Aged↗