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PubMed1988

Embolectomy for acute pulmonary artery occlusion following Fontan procedure.

A 5-year-old child experienced acute hemodynamic decompensation and hypoxia four weeks following an uneventful Fontan procedure for univentricular heart. Cardiac catheterization revealed complete occlusion of the left pulmonary artery, and emergent pulmonary artery embolectomy was performed. The source of the embolus was the atrial septal patch. Because of the altered hemodynamics following the Fontan procedure, stasis of right atrial blood and thrombus formation may occur. Routine anticoagulation immediately following operation is recommended. Prompt diagnosis and treatment with embolectomy may be lifesaving.

Cardiac Catheterization↗
PubMed1978

[Surgical treatment of massive pulmonary embolism. (Reported of 45 successful embolectomies inclusive 10 with Trendelenburg's technic) (author's transl)].

45 pulmonary embolectomies have been carried out successfully, 10 by Trendelenburg's procedure, 35 with extracorporeal circulation. The latter method gives satisfactory results (34 survivals out of 36 attempts since 1970) and appears to be the procedure of choice. Any pulmonary trauma should be avoided at operation; embolectomy is done by intra-vascular suction. The hemodynamic status was always abnormal: 5 initial cardiac arrests, 20 cases of severe shock (9 demonstrating cardiac arrest on the operating table) and 11 cases with less severe shock. In 9 cases cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. In 9 patients the operation was performed after an unsuccessful trial of thrombolysis. Preoperative pulmonary angiography could be performed in 30 cases and always showed extensive pulmonary vascular obstruction of 60 to 95 per cent. These data are important for diagnosis and for assessment of the prognosis. Despite of present medical treatment with fibrinolytics, surgery is still advisable in the treatment of massive pulmonary embolism. The indications are moribund patients, those in whom thrombolysis is contraindicated or unsuccessful and those with massive pulmonary obstruction (greater than 60 per cent). In this latter subset thrombolytic therapy carries a high level of mortality.

Clot Retraction↗
PubMed1977

[Results of embolectomy in massive pulmonary embolism (author's transl)].

In ten patients successful embolectomy after acute massive pulmonary embolism was performed. Clinical symptoms included circulatory arrest and shock as well as collaps, syncope and dyspnoe. Pulmonary angiography regularly showed massive, bilateral emboli. In 9 patients more than one half of the pulmonary artery system was involved (perfusion defect more than 50%). Right heart catheterization demonstrated pulmonary hypertension in all cases. In 8 patients the pulmonary artery mean pressure (PAm) exceeded 30 mm Hg. In 9 patients there were signs of right heart failure (RVEDP more than 11 mm Hg). At recatheterization 6 to 30 (mean 19) days after operation using cardiopulmonary bypass there was a marked improvement of pulmonary angiograms, which were normal in 3 cases. PAm decreased from 34.3 mm Hg to 14.6 mm Hg postoperatively and RVEDP from 14.4 to 5.1 mm Hg (p less than 0.001). These results confirm, that pulmonary embolectomy leads to a good functional results.

Acute Disease↗
PubMed1975

[Pulmonary embolism: indication for and results of embolectomy under cardio-pulmonary bypass (author's transl)].

Pulmonary embolectomy under cardio-pulmonary bypass was performed in five patients with massive embolism. Two survived and were ultimately discharged; two died after 40 and 101 days, respectively, of the underlying disease; one patient--operated on under a mistaken diagnosis--was maintained under assisted circulation but died after four days of the underlying disease (cardiac failure). Indications for pulmonary embolectomy under cardiopulmonary bypass should be widened, as it is the only life-saving measure in most cases. After moderately severe pulmonary embolism (lobar embolism) indications for surgical intervention must be individualised from case to case.

Aged↗
PubMed1993

Emergent middle cerebral artery embolectomy: a useful technique for cranial base surgery.

Given the poor natural history of untreated symptomatic acute middle cerebral artery occlusion, we have attempted emergent reperfusion in all three cases of acute embolic middle cerebral artery occlusion seen on our cranial base service over the last 10 years. One patient developed a massive stroke requiring a life-saving "strokectomy" within 48 hours, which left him permanently hemiplegic, hemianopic, and hemihypesthetic after a failed attempt at reperfusion by superselective endovascular injection of urokinase. The other two patients, who were aphasic and densely hemiparetic, underwent successful emergent embolectomy with reperfusion established within 5 and 12 hours, respectively. One of the two is now neurologically normal, and the second is left with a subtle monoparesis but is independent in activities of daily living. Since middle cerebral artery embolism in cranial base patients usually occurs in a closely monitored hospital setting, we are presented with a unique opportunity for early successful operative intervention. Principles for optimizing outcome include: early recognition and diagnosis, maximization of medical therapy during the diagnostic workup prior to embolectomy (induced hypertension, intravascular volume expansion, and pharmacologic cerebral metabolic demand reduction), confirmation that the involved region does not have absent blood flow by xenon/computed tomography, early operative intervention, and careful surgical technique.

Journal Article↗
PubMed1978

Improved limb salvage after arterial embolectomy.

Between January 1965 and August 1977, 122 patients with 135 arterial emboli were treated on the Peripheral Vascular Service at the Ohio State University Hospital. The heart was the source of the embolus in 94 patients (77%), one-third of whom had experienced a myocardial infarct. Thirteen patients died after the operation, which in 102 patients (84%) consisted of embolectomy only, making the hospital mortality 10.6%. Fourteen patients (11.5%) required subsequent amputations during the same hospitalization or on a later admission. The corrected limb salvage rate of 80.9% was unrelated to the length of delay in presentation. Although only 70 patients (57.4%) had palpable distal pulses following operation, 89 (73%) had a functional limb at the time of discharge or on later follow-up. An aggressive approach to the patient with an arterial embolus, regardless of the duration of symptoms, is urged. Embolectomy under local anesthesia is advocated in all cases after prompt correction of fluid and electrolyte imbalance and stabilization of the underlying cardiac disorder, except in patients with frank gangrene and irreversible rigor. In the absence of distal pulses or obvious revascularization, an intraoperative arteriogram is mandatory.

Adult↗
PubMedDate not supplied

Concomitant pulmonary embolectomy and excision of a left atrial myxoma.

We report a rare case of concomitant pulmonary embolectomy and excision of a left atrial myxoma. A 64-year-old obese woman developed a pulmonary embolism 13 days after an operation for a brain tumor. Echocardiography revealed a 3-cm left atrial mass attached to the atrial septum. Urgent surgery, including pulmonary embolectomy and excision of the left atrial mass, was performed. Histopathology confirmed that the mass was a left atrial myxoma. The postoperative course was uneventful.

Brain Neoplasms↗
PubMed1972

Late embolectomy.

Embolectomy with a balloon catheter even up to two months after embolism may be successful. Late embolectomy, meaning operation more than 48 hours after embolism, should be undertaken in a hospital where all facilities for arterial reconstruction are available.

Aged↗
PubMed1988

Pulmonary embolectomy for acute massive pulmonary embolism: an analysis of 71 cases.

Between 1964 and 1986 a total of 71 pulmonary embolectomies were performed for acute massive pulmonary embolism. All patients were severely compromised haemodynamically. Sixteen (64%) of 25 patients who had sustained significant periods of cardiac arrest before operation died. The principal cause of death in this group was severe neurological damage. Five (11%) of the 46 who had not had a cardiac arrest died. The 50 (70%) patients who survived did so largely without morbidity during their hospital admission and in the follow up period. Most were not treated with long term anticoagulants and only two had another embolism. When a patient with acute massive pulmonary embolism is too ill to be given thrombolytic treatment, or when thrombolysis is either contraindicated or too slow in producing benefit, pulmonary embolectomy remains an effective alternative treatment with an acceptable mortality.

Acute Disease↗
PubMed1976

Haemorrhagic pulmonary oedema: post-pulmonary embolectomy.

A case of haemorrhagic pulmonary oedema after successful pulmonary embolectomy is presented. The relevant literature is reviewed. Thirteen cases are analysed as well as the four survivors. The aetiology appears to be ischaemic damage of the capillary bed. This had previously been called incomplete infarction by Castleman. The incidence is low after acute pulmonary embolectomies but appears to be much higher after chronic endarterectomies, especially with severe pulmonary hypertension. Therapy is outlined.

Adult↗
PubMed1986

Balloon embolectomy catheter used percutaneously.

Percutaneous arterial embolectomy was performed following percutaneous transluminal angioplasty in three patients using Fogarty balloon embolectomy catheters. This technique is effective for the treatment of arterial embolism resulting from angioplasty in selected situations.

Angioplasty, Balloon↗
PubMed1992

Acute embolic occlusions of the infrainguinal arteries: percutaneous aspiration embolectomy in 102 patients.

Percutaneous aspiration embolectomy (PAE) was performed on acute embolic occlusions of infrainguinal arteries unrelated to percutaneous transluminal angioplasty or chronic atherosclerotic arterial occlusive disease. Of 102 patients, most (62.7% [n = 64]) had limb-threatening ischemia (stages III and IV according to the Fontaine classification); 86.3% (n = 88) had cardiac disease that caused the embolic occlusion. The clinical success rate was 87.3% (n = 89). Major complications occurred in 8.8% (n = 9) of the cases. The 30-day mortality was 3.9% (n = 4). In comparison with Fogarty-catheter embolectomy, PAE has a higher success rate and a lower mortality. PAE has several advantages: It is a simple technique with reduced invasiveness, combines a diagnostic and a therapeutic procedure, enables treatment of tibial and pedal vessels, and can be combined with all other angioplastic methods.

Acute Disease↗
PubMed2003

Suspected pulmonary artery disruption after transvenous pulmonary embolectomy using a hydrodynamic thrombectomy device: clinical case and experimental study on porcine lung explants.

PURPOSE: To use porcine lung explants for reconstructing possible situations in which a vessel wall disruption might have occurred in a patient suffering fatal hemoptysis after pulmonary embolectomy with a hydrodynamic thrombectomy device. METHODS: A 76-year-old woman with massive pulmonary embolism underwent transvenous pulmonary embolectomy using a 6-F AngioJet Xpeedior catheter according to manufacturer's instructions. While activating the device in the middle lobe artery (approximately 8 mm diameter), massive and ultimately fatal arterial bleeding occurred through the tracheal tube. Because no autopsy was authorized, an experimental study was designed to examine possible causes for the vessel disruption. Five fresh porcine heart-lung preparations were examined inside a dedicated chest phantom. Access to the pulmonary vessels was provided through catheters inside the right and left ventricular outlets. A low-flow circulation was maintained with an external pump. The 6-F AngioJet thrombectomy device was activated at 42 sites inside vessels from 2 to 10 mm in diameter; in one lung, 8 activations were made after deliberately withdrawing the guidewire. RESULTS: Vessels >6 mm in diameter remained intact. Vessel wall disruption occurred in 4 of 7 vessels between 4 and 6 mm in diameter and in 13 of 14 segmental arteries <4 mm in diameter (regardless of whether or not a guidewire was used). The signs of vessel wall disruption included extravasation of contrast material, arteriovenous fistula, and laceration of distal airspaces with contrast inside the bronchus. CONCLUSIONS: The application of this system has to be considered potentially dangerous when activated inside vessels with diameters <6 mm. The use of this device appears to be safe only inside main branches of the lung vessels at this time. Additional experiments will be required to substantiate these initial results.

Aged↗
PubMed1977

Transvenous pulmonary embolectomy for acute massive pulmonary embolism.

Transvenous pulmonary embolectomy employing a vacuum-cupped directionally controlled catheter is a relatively new technique used in the management of major pulmonary embolism. We present the findings in a patient with acute massive pulmonary embolism who underwent transvenous pulmonary embolectomy, with immediate and marked improvement in hemodynamic function and survival. Insertion of a new intracaval filter at the same time provided protection against recurrent thromboembolism.

Acute Disease↗
PubMed2004

Use of a Fogarty Embolectomy Catheter to Retrieve a Foreign Body during Redo Coronary Artery Bypass Surgery: Case Report.

Abstract We report the successful use of an embolectomy catheter to retrieve a metal bullet tip of a cardiotomy suction device that was lost during redo coronary artery surgery. The metal tip was lost somewhere in the vicinity of a tear created in the ascending aorta during repeat sternotomy. Initial attempts at retrieval using a Foley catheter were made but were unsuccessful. The foreign body was successfully retrieved by withdrawing an inflated Fogarty balloon embolectomy catheter. The patient went on to have coronary artery bypass grafting and made a sound recovery from the operation.

Journal Article↗
PubMed1975

Arterial embolectomy before and after the Fogarty catheter.

Arterial emboli were extracted from 79 patients between 1955 and 1963 with polyethylene catheter suction systems and/or retrograde flushing and from 149 patients between 1963 and 1973 with Fogarty catheters. The Fogarty-era patients were older, had a greater incidence of ischemic heart disease, and presented with a greater degree of preoperative peripheral ischemia. The limb salvage rate of 87 percent after Fogarty catheter embolectomy was not statistically different from the salvage rate of 79 percent after suction catheter embolectomy, but the number of limbs with distal pulses postoperatively was significantly greater after Fogarty treatment, 64 vs. 42 percent. Delay in treatment and the presence of prior occlusive vascular disease adversely affected results in both eras. The in-hospital embolic recurrences occurred in 9 percent of the patients anticoagulated postoperatively and in 31 percent of those not anticoagulated. Heparin and warfarin were equally effective in preventing recurrences, but wound complications were seen in 33 percent of the heparinized patients, compared with 7 percent of those receiving warfarin and 4 percent of those not anticoagulated.

Aged↗
PubMed1975

[Our experience with peripheral arterial embolectomy].

34 cases of acute peripheral ischaemia examined in recent years at the University of Messina General Surgery Clinic are presented. 16 were subjected to embolectomy according to Fogarty. The remaining 18 received protracted medical therapy. Some successes were obtained. In other cases, gangrene necessitated amputation of the affected limb. Satisfactory results were observed in 70% of the operated series. Success was more marked when only a short interval was left between the embolic episode, with progressively poorer results as the penalty for delay. The long-term results of embolectomy are related to the nature of the underlying disease and the treatment given after surgery.

Aged↗
PubMed1975

Mortality rate following lower limb arterial embolectomy: causative factors.

The series reported includes 85 patients who underwent arterial embolectomy for 101 embolic events. The over-all hospital mortality rate following embolectomy was 41 percent. The etiological factors for this high mortality rate are analyzed. The group includes 58 patients who had arteriosclerotic heart disease and 27 patients with rheumatic valvular disease. The mortality rate encountered in the arteriosclerotic group of patients was 52.9 percent, whereas that in the rheumatic group of patients was 18 percent. The major cause of death was cardiorespiratory failure (51 percent). Factors which weighed heavily on the final outcome were previous myocardial infarction, hypertension, diabetes, cardiac decompensation, and rhythm disturbances. Limb salvage was accomplished in 51 patients (60 percent). Amputation was performed in 17 patients (20 percent).

Adult↗