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At least 163 records · Page 9Linked to original sources
PubMed1992

[Surgical treatment of acute intestinal ischemia. Successful treatment with embolectomy of the superior mesenteric artery].

We describe a patient with acute intestinal ischemia successfully treated with embolectomy of the superior mesenteric artery. Over the last four years, 11 patients with the same disease were treated with bowel resection at Nordland Regional Hospital. The mortality rate after bowel resection was 45%. Long duration of symptoms, and high frequency of associated cardiovascular disease was characteristic. In elderly patients with acute abdominal pain and cardiovascular disease, a diagnosis of acute mesenterial ischemia should be seriously considered. In patients with acute mesenteric ischemia and no bowel necrosis, embolectomy must be considered in preference to bowel resection.

Abdomen, Acute↗
PubMed1992

Acute pulmonary embolectomy with cardiopulmonary bypass support.

Deep venous thrombosis and pulmonary thromboembolism remain major sources of patient morbidity and mortality. The authors present the case of a 55-year-old man with a massive pulmonary embolism and subsequent hemodynamic decompensation who was successfully treated by open pulmonary embolectomy supported with cardiopulmonary bypass. Indications for embolectomy and patient selection as well as technical considerations are discussed.

Cardiopulmonary Bypass↗
PubMed1991

Factors affecting limb salvage and mortality in patients undergoing femoral embolectomy.

The management and outcome of 131 acute femoral arterial occlusions in 126 patients over a period of 7 years is presented. The emboli were of cardiac origin in 82% of cases; 96% of the patients were treated with thromboembolectomy. The overall mortality rate was 26% with a limb salvage rate of 88% amongst the survivors. There was an increased risk of mortality in patients having both atrial fibrillation and myocardial infarction, saddle emboli and those having delayed embolectomy after 24 h. Only the latter was found to be statistically significant. One-third of the patients who died had a failed embolectomy. An early fasciotomy helped in preventing permanent neurological deficit in patients with compartment syndrome.

Acute Disease↗
PubMed1990

[Follow-up in femoral artery embolectomy].

The results of 112 femoral embolectomies performed on 100 patients were reviewed. Operative mortality rate was 15% and early amputation (within 30 day-after the procedure) 18%. The role of early amputation was closely related to the time of leg ischemia. Current follow-up as established for 86 patients. 5 years and 10 years survival rates for the group were 49% and 40%. Although early survival is decreased after femoral embolectomy long term survivors can be expected to live independently with excellent limb salvage and function.

Adult↗
PubMed1990

Balloon embolectomy catheter-induced arterial injury: a comparison of four catheters.

This study compared four brands of balloon embolectomy catheters with respect to their mechanical characteristics and the histologic responses they elicit. Seventy-two 4F Becton-Dickinson, Edwards, Electro-Catheter, and Shiley catheters were studied. In vitro studies of penetration forces demonstrated that the forces required for arterial puncture were greatest for Shiley (295 +/- 22 gm) and least for Edwards catheter tips (217 +/- 11 gm) (p less than 0.05). This indicates that the Shiley catheter is least likely to puncture vessels in patients. Studies of balloon eccentricity showed that none of the balloons distended with excessive eccentricity. Studies of balloon emptying time demonstrated that the silicon Becton-Dickinson balloon required more than two times as long (5.7 +/- 1.2 seconds) as all other balloons to empty. Balloon emptying time reflects the ability of the surgeon to rapidly adapt the balloon to changing vessel diameter in patients. Shear forces were studied in cylindrical segments of arteries in vitro. Initial shear forces were significantly different among all catheters, Becton-Dickinson greater than Edwards greater than Shiley greater than Electro-Catheter (p less than 0.05). In contrast, during catheter withdrawal dynamic shear forces were similar among the four brands of catheters. Balloon embolectomies were performed in vivo in the common carotid and common femoral arteries in 18 anesthetized dogs. Histologic examinations of the vessels exposed to 50, 100, and 200 gm shear forces showed that myointimal hyperplasia increased with rising shear forces for all catheters (p less than 0.05), but that there were no differences in the degree of myointimal hyperplasia elicited by the different brands of catheters.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Intraoperative intra-arterial urokinase infusion as an adjunct to Fogarty catheter embolectomy in acute arterial occlusion.

Sixteen patients, seven men and nine women (mean age of 66 years), with acute arterial ischemia were treated with operative thromboembolectomy by Fogarty catheterization and urokinase. Seven patients were diabetic, ten were hypertensive and six had prior vascular surgical treatment. The operative arteriograms confirmed vascular occlusive phenomenon. The ankle to brachial ratio was a mean of 0.02. Perioperatively, patients had anticoagulation with heparin systemically. All patients underwent transfemoral embolectomy using a Fogarty catheter. An initial retrieval of clots was accomplished, with documentation by arteriography, instillation of urokinase (50,000 units) and clamping of vessel for 15 minutes. Subsequent passage of the Fogarty catheter and repeat urokinase infusion resulted in further retrieval of clots and improvement by repeat intraoperative arteriography. All interventions resulted in clinical restoration of perfusion to the affected limb. Six patients had amputations of the lower extremities (one transmetatarsal and one below the knee) during the 30 day postoperative period. Improvement in distal run-off was demonstrated by intraoperative arteriography and increases in the ankle to brachial ratio from 0.1 to 1.04, with a mean of 0.54, were noted. No complications from bleeding occurred. One patient died postoperatively because of myocardial infarction. Salvage of the limb may increase with combined embolectomy and thrombolytic therapy.

Acute Disease↗
PubMed1989

[A case of acute massive pulmonary embolism successfully treated with transvenous pulmonary embolectomy by catheter].

A 78-year-old woman, suffering from acute massive pulmonary embolism, was successfully treated with transvenous pulmonary embolectomy by catheter. This patient had been suffering from oppressive chest sensations during exercise, and diagnosed and treated as angina pectoris at a nearby clinic. She consulted our hospital complaining that her chest pains were increasing in frequency. She was admitted to our hospital on July 7, 1988, for coronary angiography (CAG), which she underwent on July 8 by the right femoral approach. After the CAG, she was ordered to rest in bed overnight, with the right inguinal region compressed. 18 hours later, the compression was removed and she was allowed to walk. Soon after she walked to the toilet, she complained of chest discomfort and fell into shock (systolic blood pressure was 60 mmHg). An ECG examination showed a right bundle branch block and an inverted T wave in lead V1-3. An echocardiography showed normal contraction of the left ventricle, but an enlargement of the right ventricle and a flattened interventricular septum. An analysis of arterial blood gas showed hypoxia (Pao2 52.5 mmHg, Paco2, 30.9 mmHg). Acute pulmonary embolism was suspected. 240,000 units of urokinase were administered intravenously, and pulmonary angiography was performed immediately. It revealed that the bilateral pulmonary arteries were almost completely obstructed. Although 720,000 units of urokinase were infused into the pulmonary artery, the obstruction did not improve. At that time, we performed a transvenous pulmonary embolectomy. We used a Judkins R 4 guiding catheter for PTCA made by USCI. The catheter was inserted into the pulmonary artery and clots were aspirated with a syringe.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1988

Peripheral arterial embolectomy, risks and results.

Embolectomy of the extremities was performed on 221 patients (263 emboli) with median age 77 years. The upper extremity was affected in 21% of cases. No correlation was found between the time from onset of symptoms to embolectomy and the amputation rate. There were 81 deaths (37%) within a month of operation. The mortality rate was significantly higher (47%) among the patients who were already in hospital when embolism occurred and also when the embolism was associated with myocardial infarction (68%). Among patients given oral anticoagulants postoperatively the perioperative mortality was 5%, compared with 51% without such medication. Patient age, concomitant coronary artery disease and oral anticoagulant treatment were factors independently influencing morbidity during the first postoperative month. The 5-year survival rate was also significantly heightened by anticoagulant treatment (43 vs. 12%). Data concerning amputation rate, perioperative mortality and long-term survival in relation to oral anticoagulant treatment must be cautiously interpreted. Prospective trials are required to answer some of the questions.

Adult↗
PubMed1987

Hypermyoglobinemia after successful arterial embolectomy.

Myoglobin concentrations in serum and urine were measured in eight patients who underwent successful arterial embolectomy in the femoral or iliac arteries. Median serum myoglobin levels significantly increased after revascularization to a maximum of 4741 micrograms/L (reference range: 0 to 80 micrograms/L) 2 hours postoperatively, with a concomitant and correlated increase in the urine myoglobin concentration. Three days after the operation, serum myoglobin concentrations were still substantially elevated in three patients. None of our patients suffered permanent renal damage, but transient renal impairment was noted in five patients, as evaluated from the serum and urine beta 2-microglobulin concentrations. We found an association between the concentrations of myoglobin in serum and urine (Spearman's rho: 0.66; p less than 0.001) and between the concentrations of myoglobin in urine and beta 2-microglobulin in urine (Spearman's rho: 0.65; p less than 0.001). Our results indicate a transient renal impairment associated with hypermyoglobinemia and myoglobinuria, even after successful arterial embolectomy.

Aged↗
PubMed1988

Balloon embolectomy catheter shear force gauge.

The shear force gauge is a device that will allow surgeons to develop a sense for the amount of shear force exerted on the arterial endothelium during balloon embolectomy. As a teaching device, hopefully it will decrease the number of shear force related complications connected to the use of the balloon embolectomy catheter.

Arteries↗
PubMed1986

Pulmonary embolectomy: a 25 year experience.

For the past 25 years an emergency pulmonary embolectomy service has been offered to the hospitals serving a conurbation of 1.5 million. Fifty-five of these procedures have been performed during a short period of normothermic circulatory standstill produced by clamping the superior and inferior venae cavae. Of 36 patients who underwent pulmonary embolectomy without an episode of asystole or ventricular fibrillation, 35 survived the operation (97.2%). However, there were seven deaths during the postoperative period, three related to pulmonary embolism and four to other causes (mortality 20%). Conversely, in a group of 19 patients who had an episode of cardiac arrest, 14 died during or after the operation of pulmonary embolism and two of unrelated causes (mortality 73.7%). In properly selected patients this technique achieves a satisfactory measure of success. It can be used in hospitals that do not have cardiac surgical facilities and, because of its simplicity, it can be performed during the early period after pulmonary embolism when the risk of death is greatest.

Adolescent↗
PubMed1985

Pulmonary embolectomy: a review.

Massive pulmonary embolism continues to be a major cause of death in spite of improved medical therapy. Only a small number of patients with pulmonary embolism refractory to medical treatment are referred for pulmonary embolectomy. A literature review of patients with massive pulmonary embolism treated by pulmonary embolectomy showed that the operation was highly successful in those who were unlikely to survive with other modes of therapy. Specific indications and management are outlined on the basis of these cumulative data.

Cardiopulmonary Bypass↗
PubMed1985

Balloon embolectomy catheters in small arteries: a technique to prevent excessive shear forces.

Balloon embolectomy catheters were studied in canine common carotid arteries (2 to 3 mm) in vitro to evaluate a technique of preventing excessive shear forces and to examine the effect of blood within the lumen. Each balloon was studied at 25, 75, 125, or 150 mm Hg lateral wall pressure. Shear forces were recorded in 16 vessels when the balloons were distended before catheter withdrawal, and these data were compared with forces recorded when the balloons were distended during catheter withdrawal. Results showed that distention of the balloon during withdrawal reduced shear forces 43.8% to 55.8% (p less than 0.05). In other experiments shear forces were recorded when the lumen was lubricated with heparinized saline solution, and these were compared with forces recorded when the lumen was lubricated with heparinized whole blood. The presence of blood in the lumen reduced shear forces 23.4% to 52.9% (p less than 0.05). From these studies it is recommended that during embolectomy in patients the balloons be distended during the first half centimeter or centimeter of catheter withdrawal to prevent excessive shear forces and that residual blood in the vessel lumen proximal to the point of embolic obstruction be accepted without concern, provided adequate heparinization has been achieved.

Animals↗
PubMed1979

[Indication margins for pulmonary embolectomy].

Pulmonary embolectomy is the most effective form of treatment in acute, massive pulmonary embolism. Persistent cardio-respiratory failure, in spite of intensive medical therapy, presents a clear indication for embolectomy. A relative indication is given with the occlusion of more than 50% of the pulmonary arterial tree, especially in the case of beginning circulatory failure and contraindications to fibrinolytic therapy. Preoperative angiography is essential and should be performed whenever possible. A dramatic deterioration of the patient's condition may, however, require a prior reestablishment of sufficient circulation with relief of the right ventricle. According to the clarity of symptoms, either immediate thoracotomy or peripheral canulation and partial cardio-pulmonary bypass with subsequent angiography on the operating table should be preferred. Even a long resuscitation with persistently dilated, non-reactive pupils does not exclude operative success, and justifies neither the ommission nor the premature discontinuance of a resolute and consistent therapy.

Acute Disease↗
PubMedDate not supplied

An unusual late complication of superior mesenteric embolectomy.

Few complications of superior mesenteric artery embolectomy have now been reported. We present the case history of a patient who developed duodenal obstruction due to a haematoma forming in the root of the mesentery following successful superior mesenteric embolectomy. The aetiology is discussed and a method of avoiding this complication suggested.

Duodenal Obstruction↗
PubMed1978

Pulmonary embolectomy.

Embolectomy was carried out in eight patients with pulmonary emboli. Angiographic diagnosis was obtained in six, and in two cases pulmonary angiography could not be done because of the very critical condition of the patients. In the latter two, diagnosis was made based only on clinical findings. Two patients died in the operating room (25 percent). Six patients were discharged in good condition. It is emphasized that pulmonary embolectomy should be done in cases of pulmonary emboli when a clinical status of shock is present (systolic blood pressure less than 80 mm of mercury and the patient in low cardiac output syndrome) and when there is no response to medical treatment regardless of the degree of obstruction in the pulmonary arterial tree.

Adult↗
PubMed1983

Balloon embolectomy catheters in small arteries. III. Surgical significance of eccentric balloons.

Some embolectomy balloons distend eccentrically. This study was undertaken to compare balloon eccentricity in air with that which occurs in arteries, to determine the influence of balloon eccentricity on shear force, and to estimate the injury potential of eccentric balloons. We studied 21 Edwards and 17 Shiley catheters in 24 dog carotid arteries in vitro. Each vessel was mounted horizontally in a Krebs-Ringer bath with one end of the vessel suspended from a force gauge. Catheters were inserted through an arteriotomy, and balloons were distended to lateral wall pressures of 25, 75, and 125 mm Hg. X-ray studies were used to measure balloon eccentricity--that is, the ratio of larger radius (R) to smaller radius (r). Comparison revealed a high correlation (r = 0.88, P less than 0.05) between R/r values in air and R/r values within arteries. Shear forces were produced when balloons were withdrawn through arteries. Regression equations revealed that the shear force increased about 10% for each unit increase in R/r. However, extremely eccentric balloons (R/r 8:1) pushed the catheter shaft deep into the vessel wall, gouging a linear tear in the media. This was seen in vitro and in two dogs studied 2 and 14 days after embolectomy. We conclude that balloon eccentricity in air is an accurate indicator of balloon eccentricity within arteries, that moderately eccentric balloons (R/r 3:1) are acceptable for clinical use, but that extremely eccentric balloons (R/r greater than 3:1) may cause severe injury and should not be used in the operating room.

Animals↗