Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Embolectomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,207 records · Page 67Linked to original sources
PubMed1993

Direct revascularization for the treatment of forearm and hand ischemia.

During an 8-year period, 65 patients underwent operation for ischemia of the arm and hand. Fifty-four patients presented with an acutely ischemic extremity. Twenty-two had cardiac origin emboli, 9 had arterial-arterial emboli, 8 had traumatic occlusion of the brachial artery, and 15 patients developed arterial insufficiency after iatrogenic intervention. Twenty-one of 22 patients with cardiac emboli were successfully treated with embolectomy alone. The majority of patients with arterial-arterial emboli and traumatic or iatrogenic injuries required arterial reconstruction in addition to clot retrieval. After operation, 53 of 54 patients were asymptomatic. Eleven patients underwent operation for chronic ischemia. Seven patients had axillo-brachial saphenous vein grafts, two had carotid-subclavian bypass grafts, and two patients underwent aorto-innominate bypass. All grafts remained patent during follow-up that ranged from 6 months to 8 years. We conclude that operative therapy is very effective in preventing limb loss and functional impairment in patients with acute or chronic upper extremity ischemia.

Adolescent↗
PubMed1998

Acute occlusion of the abdominal aorta.

BACKGROUND: Acute aortic occlusion most commonly results from aortic saddle embolus or thrombosis of an atherosclerotic abdominal aorta. The purpose of this study was to review the experience at a university hospital to better define the diagnosis and management of this uncommon process. METHODS: A retrospective chart review was performed from patients admitted to Emory University Hospital with acute occlusion of the abdominal aorta from 1985 through 1997. RESULTS: Thirty-three patients were identified. In group EMB (n = 16), occlusion was due to saddle embolus. In group IST (n = 17), occlusion was attributed to in situ thrombosis of a severely diseased aorta. Operative procedures performed included transfemoral embolectomy (15), aorto-bifemoral bypass (9), axillobifemoral bypass (5), fasciotomy (3), and thrombolysis (1). The in-hospital mortality rate was 21% (31% EMB, 12% IST), and morbidity was significant and included mesenteric ischemia (6%), bleeding complications (9%), subsequent amputation (12%), renal failure (15%), recurrent embolization or thrombosis (21%), and cardiac complications (42%). CONCLUSIONS: Acute aortic occlusion has tremendous morbidity and mortality even with optimal surgical care.

Acute Disease↗
PubMed1995

Upper extremity thromboembolism caused by occlusion of axillofemoral grafts.

BACKGROUND: The axillofemoral bypass graft (AxFG) is increasingly accepted as treatment for lower extremity ischemia caused by aortoiliac occlusive disease in high-risk patients. The incidence of upper extremity (UE) thromboembolism caused by occlusion of an AxFG and the results of treatment form the basis for this report. METHODS: From 1984 to the present, all patients undergoing axillofemoral bypass grafting were followed up in a vascular registry. A standardized operative technique, using an externally supported 8-mm polytetrafluoroethylene graft, was used in performing 202 AxFGs in 182 patients. UE thromboembolism caused by occlusion of an AxFG was identified by retrospective patient record review. RESULTS: Occlusion of an AxFG occurred in 20 patients. Fifteen patients (75%) underwent immediate revision of the occluded graft. Two patients (10%) developed UE thromboembolism simultaneous with graft occlusion. One of these patients had immediate revision of the graft, and 1 had brachial embolectomy only. This patient and 4 others (25%) had the occluded AxFG left in place. Four of these 5 patients (80%) developed UE thromboembolism at 26 days, 2 years, 5 years, and 7 years, respectively, after occlusion. Overall, six UE thromboembolic complications occurred in 5 patients. CONCLUSIONS: UE thromboembolism represents a significant and specific complication of occluded AxFGs in our series (2.7% of patients, 25% of occluded grafts). It may be prudent to prophylactically detach the axillary portion of the graft and repair the axillary artery in patients who do not require immediate revision of an occluded AxFG.

Algorithms↗
PubMed2000

Dramatic improvement of LV function after coronary sinus thromboembolectomy.

We present the case of a 79-year-old man suffering from chronic atrial fibrillation, severe left ventricular dysfunction, massive right atrial thrombosis, and pulmonary hypertension. Complete coronary sinus thrombosis was found incidentally during preoperative screening. Successful coronary sinus, right atrial, and pulmonary operative embolectomy was followed soon after by a dramatic improvement of cardiac performance; the patient's left ventricular function recovery, in particular, suggests that cardiac venous system played an important role in the genesis of myocardial impairment.

Aged↗
PubMed2004

Successful treatment of massive pulmonary embolism in the 38th week of pregnancy.

In 1998, a 32-year-old woman in week 38 of pregnancy was referred to our hospital because of swelling of the lower extremities and dyspnea at rest. A massive pulmonary embolism and thrombi in the right and left atria were detected. After a successful cesarean section, emergent pulmonary embolectomy was performed with the use of cardiopulmonary bypass. Both the mother and the fetus recovered without severe complications. Postoperatively, activated protein S deficiency was detected.

Adult↗
PubMed1994

Percutaneous aspiration thromboembolectomy to manage the embolic complications of angioplasty and as an adjunct to thrombolysis.

Percutaneous aspiration thromboembolectomy (PAT) can be used to treat the embolic complications of angioplasty. The same technique is of value during thrombolysis to remove large pieces of thrombus. We report on our experience with PAT in 21 patients. Fourteen of these patients had embolization complicating peripheral angioplasty and in one case embolus complicated directional atherectomy. PAT was successful in 87% of these patients (13/15). In six patients undergoing thrombolysis of acute peripheral occlusions, all had successful PAT to shorten their treatment episode immediately prior to angioplasty of any underlying stenosis. PAT can be performed with a simple, inexpensive catheter under fluoroscopic control and therefore offers significant advantages over a surgical embolectomy using the Fogarty balloon catheter. PAT is a useful treatment option for the vascular radiologist.

Aged↗
PubMed2003

In-hospital and long-term outcome after sub-massive and massive pulmonary embolism submitted to thrombolytic therapy.

BACKGROUND: From a registry of 249 confirmed pulmonary embolism (PE) patients submitted to thrombolytic therapy (TT), we analysed predictors of in-hospital course and long-term mortality. METHODS AND RESULTS: The combined clinical end point of in-hospital course associated death, recurrent PE, repeat thrombolysis, surgical embolectomy or bleeding complications. The long-term follow-up included analysis of survival, and occurrence of PE-related events, defined as recurrent deep vein thrombosis, recurrent PE, occurrence of congestive heart failure or change of New York Heart Association functional class to class III or IV in patients who survived the acute phase.In-hospital clinical course was uneventful in 165 (66.3%) patients. Initial right ventricular (RV) dysfunction was reversible in 80% within 48 h following TT. Initial pulmonary vascular obstruction >70% (RR=5.3 [2.1; 13.6]); haemodynamic instability at presentation (RR=2.6 [1.1; 6]); persistence of septal paradoxical motion after TT (RR=5.9 [1.4; 25.9]); and insertion of intracaval filter (RR=3.7 [1.4; 9.4]) were independent predictors of poor in-hospital course. Mean follow-up was 5.3+/-2.6 years. Of the 227 patients alive after the hospital stay, the probability of survival was 92% at 1 year, 79% at 3 years and 56% at 10 years. Multivariate predictors of long-term mortality were age >75 years (RR=2.73 [2.18; 3.21]; P=0.0002), persistence of vascular pulmonary obstruction >30% after thrombolytic treatment (RR=2.22 [1.69; 2.74]; P=0.003), and cancer (RR=2.03 [1.40; 2.65]; P=0.04). CONCLUSION: The recovery of RV function should be considered as a marker of thrombolysis efficacy, while residual pulmonary vascular obstruction and cancer are independent predictors of long-term mortality. These results advocate the identification of high-risk patients by means of systematic lung-scan and echocardiography pre- and post-thrombolysis, and raise the question of the need for thromboendarterectomy in patients with residual pulmonary vascular obstruction.

Adolescent↗
PubMed2001

Contribution of pulmonary vasoconstriction to haemodynamic instability after acute pulmonary embolism. Implications for treatment?

Acute pulmonary embolism with haemodynamic instability has a high mortality rate. Death results from an acute increase in right ventricular afterload, and the commonly held view is that mechanical obstruction of the pulmonary vascular bed is largely responsible for this increase. In accordance, recent treatment guidelines for severe pulmonary embolism focus exclusively on interventions aimed at relieving this mechanical obstruction, either by thrombolysis or (catheter) embolectomy. However, there is evidence to indicate that vasoconstriction is a very important contributor to the initial increase in pulmonary vascular resistance after pulmonary embolism. This is consistent with the observation that the degree of mechanical obstruction correlates at best poorly with haemodynamic manifestations. Thromboxane A(2) and serotonin are probably mainly responsible for pulmonary vasoconstriction. Cyclooxygenase inhibitors and serotonin antagonists have been shown in animal experiments to attenuate the haemodynamic response to acute pulmonary embolism and to reduce mortality. In addition, reports of a favourable response to pulmonary vasodilators in animals and in humans with acute severe pulmonary embolism have been published. In this paper, it is argued that we may need to reconsider our current therapeutic approach to patients with acute severe pulmonary embolism. Antagonising pulmonary vasoconstrictive mediators or administering pulmonary vasodilators may prove to be life-saving interventions in these patients.

Animals↗
PubMed2003

Pulmonary embolism.

PE is one of the great challenges in medicine. It is a disease that carries with it a high mortality rate, yet no historical piece of information, physical examination finding, or diagnostic modality is perfect at excluding its possibility. Emergency physicians must be vigilant about considering PE in the differential diagnosis of a variety of presenting complaints and must use a variety of diagnostic and therapeutic options as they manage patients with suspected or confirmed PE. The diagnostic options range from bedside diagnostic tests to highly specialized imaging available at only specialized institutions. Knowing the advantages and disadvantages of each of the diagnostic modalities assists the physician in employing the best test. Therapeutic options also vary widely and include anticoagulation, vena caval interruption, systemic thrombolysis, embolectomy, and other therapeutic adjuncts, such as ECMO and inhaled nitric oxide. Similarly, awareness of the indications and contraindications to the varied therapeutic agents ensures appropriate therapy when the diagnosis is made.

Anticoagulants↗
PubMedDate not supplied

Acute limb ischemia and heparin-induced thrombocytopenia: the value of echocardiography in eliminating a cardiac source of arterial emboli.

We report an unusual thromboembolic event occurring during severe heparin-induced thrombocytopenia. A left intraventricular thrombus was diagnosed as the source of multiple arterial emboli, resulting in an initial cerebrovascular event and subsequent bilateral acute lower extremity ischemia requiring emergency surgery. No underlying heart disease was detected. Pathologic examination of the embolectomy specimen revealed fibrin platelet aggregates with rare white and red blood cells, consistent with a "white thrombus." We conclude that routine monitoring of platelet count should be performed in all patients receiving heparin to identify promptly individuals who have heparin-induced thrombocytopenia, and when thromboembolic complications occur in this setting, echocardiography is indicated to identify possible intracardiac sources for emboli, even in patients with previously known structurally intact hearts.

Dose-Response Relationship, Drug↗
PubMed1995

Modified surgical concept for fulminant pulmonary embolism.

Surgical intervention in fulminant pulmonary embolism (PE) is still associated with an overall 30% fatal outcome which increases to about 60% when cardiopulmonary resuscitation (CPR) is necessary. Despite unfavorable conditions like hemodynamic instability, failed lysis or CPR, the surgical strategy might have a certain impact on the patient's outcome since 30-40% of the surgical mortality is related to persistent right heart failure and early thromboembolic recurrence. From 1/88 to 8/94 a total of 25 patients (15 females, 10 men, mean age 57 [25-78]) years underwent emergency pulmonary embolectomy with the use of the heart-lung machine. Seventeen patients were operated upon between 1988 and 1992. A standard approach by central pulmonary artery incision with extraction of adjacent pulmonary emboli using forceps, suction of Fogarty catheters was used. Six of these patients (35%) died, with four out of six operated upon under CPR. Since 1993 we have used a modified surgical strategy in eight patients. Five patients (63%) were operated on after or under CPR. In these cases, left and right pulmonary arteries were incised peripherally and all segmental arteries were desobliterated selectively using small suction devices. Thereafter the right atrium was opened and inspected. After removal of the inferior caval vein cannula all inferior body blood was taken with cardiotomy suction while both legs and the abdomen were massaged centripetally to mobilize additional fresh thrombotic material. In three cases up to 50 cm long thrombi could be delivered. All patients have survived to date with two patients receiving a LGM caval filter placed percutaneously after bilateral postoperative phlebography had revealed ongoing thrombotic disease. We conclude that selective desobliteration of every segmental pulmonary artery in combination with simultaneous clearance of major body veins from additional thrombotic material will probably lower surgical mortality in these critically ill patients.

Adult↗
PubMed1997

Replacement of right ventricle to pulmonary artery and right atrium to right ventricle homograft after a modified Rastelli operation.

The patient, a 17 year old boy, had undergone a Rastelli operation for transposition of the great arteries plus ventricular septal defect and left ventricular outflow tract obstruction at the age of 7 years. Associated tricuspid valve stenosis was treated with insertion of a second homograft shortly after the Rastelli operation. The patient remained symptom-free for 10 years, when he suffered femoral artery embolus. Investigation showed severe obstruction of both conduits and biventricular dysfunction with thrombus in the left ventricle. After embolectomy and stabilisation of his general condition and prolonged treatment with heparin, he underwent uneventful replacement of the two conduits. He remains well, 8 months after the operation.

Adolescent↗
PubMed2001

Interventional therapy for pulmonary embolism.

Venous thromboembolism is a common cause of death. Acute massive pulmonary embolism (PE) is life-threatening and may require vigorous more invasive treatment. Several risk factors are related to increased incidence of massive PE. Anticoagulation is the most traditional treatment for PE but may not suffice in cases of massive PE. Systemic thrombolytic therapy, catheter-directed thrombolysis, percutaneous embolectomy, and more recently, percutaneous thrombus fragmentation techniques with a multitude of devices are now available to treat the most severe cases of massive PE. Successful treatment of PE includes implementation of a treatment protocol and the use of associated techniques and devices.

Angioplasty, Balloon↗
PubMed1996

Peripheral arterial occlusions: local low-dose thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA).

OBJECTIVE: To study the efficacy and risks of local thrombolytic therapy of peripheral arterial occlusions using rt-PA. DESIGN: This open study was performed in one clinic in Munich, Germany. METHODS: 288 patients suffering from occlusions of the lower limb arteries were subjected to 336 treatments performed with a permanently controlled technique. In a short pilot study 10mg rt-PA/h were administered for 5 h but in the majority of the cases only 2.5mg/h were administered for a maximum of 5 h. The average total dose of rt-PA was 2.97mg and the average time for lysis was 78 min. RESULTS: 43 (84.3%) out of 51 embolic occlusions and 168 (71.5%) out of 235 thrombotic occlusions were recanalised with a cumulative patency of 95% and 79.7% respectively after 2 years. One systemic bleeding occurred in the pilot study with 10mg rt-PA/h whereas with the 2.5mg/h dosage no systemic bleeding or embolism occurred in the 315 treatments. There were no deaths during hospitalisation. Six major and two forefoot amputations were necessary. Thirteen patients required a bypass operation and one an embolectomy. The advantages of our controlled technique are: short duration of treatment, small doses of activating agent, an accurately directed pathway with the possibility of dilating stenoses during the same session, no danger of systemic bleeding or embolism and, therefore, good prospects of success with minimal risk. CONCLUSION: The use of rt-PA for local lysis substitutes the inadequate tissue activator available for effective spontaneous lysis and is, therefore, almost physiological. The effect of a very low dose of rt-PA was as good as that of higher doses.

Adult↗
PubMed1998

Impending paradoxical embolus: clinical imaging and successful surgical treatment.

In a patient with pulmonary emboli, transesophageal echocardiography showed a thrombus straddling the foramen ovale (impending paradoxical embolism). Proximal pulmonary emboli were visualized by spiral computed tomography and subsequent surgical treatment, consisting of removal of intracardiac clot, closure of the open foramen ovale and pulmonary embolectomy, was successful.

Echocardiography, Transesophageal↗
PubMed2002

Outpatient management of venous thromboembolic disease with subcutaneous lepirudin: a case report.

Outpatient treatment of deep venous thrombosis has gained widespread acceptance and is facilitated by the use of subcutaneous low molecular weight heparins (LMWH). We report two patients in whom subcutaneous lepirudin was used for long term anticoagulation after heart transplant or surgical pulmonary embolectomy because treatment with LMWH or warfarin was contraindicated, unsuccessful, or impractical. Neither bleeding complications nor recurrent thromboses developed. Subcutaneous lepirudin may be safely and effectively employed for the outpatient treatment of venous thrombosis in selected cases including patients with heparin-induced thrombocytopenia and in those who fail LMWH.

Adult↗
PubMed2006

[Diagnosis and therapy of pulmonary embolism].

Management of venous thromboembolism has long been characterized by a high degree of complexity and a disappointing lack of both efficacy and efficiency. The non-specific clinical signs of acute pulmonary embolism (PE) and the limitations of earlier imaging procedures such as the lung scan and pulmonary angiography led to the development of numerous sophisticated, multi-step diagnostic algorithms which, however, have proved extremely difficult to implement in clinical practice. As a result, the diagnosis of potentially life-threatening PE was frequently missed in many patients who subsequently died of the disease without receiving appropriate treatment, while other patients unnecessarily underwent a battery of invasive, time consuming procedures due to a vague, poorly documented clinical suspicion. Recently, the development of structured models for assessment of clinical pre-test probability, the widespread use of D-dimer testing in the outpatient setting, and particularly the technical advances of multidetector-row CT scan, had an enormous impact on our strategy for approaching patients with suspected PE. Contemporary diagnostic algorithms based on the above modalities are not only efficient and reliable but also simple and practicable. Furthermore, the importance of right ventricular (RV) dysfunction, even in the absence of overt hemodynamic instability, was recognized, and a number of studies demonstrated the value of echocardiography and laboratory biomarkers for risk stratification of PE. At present, low molecular weight heparins are increasingly becoming established as the treatment of choice for hemodynamically stable patients without RV dysfunction (non-massive PE), while consensus exists that patients with massive PE and cardiogenic shock necessitate emergency removal of pulmonary thrombus using thrombolytic agents, surgical embolectomy, or catheter-based thrombus aspiration. On the other hand, the treatment of stable patients with RV dysfunction (submassive PE) remains the subject of debate, and a large randomized trial is urgently needed to address the possible clinical benefits of thrombolysis in this setting.

Algorithms↗