Arterial embolectomy in lower limbs

Abstract

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.

Early Thrombosuction and Tirofiban Use in Knee and Below-Knee Arterial Thrombosis

“…Although ALI can be treated up to 14 days after injury, early intervention reduces tissue damage and improves success [39]. Interventions within 24 h has good outcomes [40,41]. In our study, we have seen the same outcomes.…”

Is Surgical Thrombo-Embolectomy in Acute Limb Ischemia Still Advantageous in Patients More Than 65 Years of Age?

“…The degree of ischemic involvement is always higher in the lower extremities because of poor collateral circulation. Wolosker et al [1996] investigated the effect of surgery on embolism but did not consider the duration of ischemia. Limb amputation occurred in 16.4% of the surviving patients (versus 13.7% in our study).…”

Predictors of In-hospital Mortality in Patients with Acute Limb Ischemia – Lesson Learnt from A Tertiary Hospital in Jakarta

“…Approximately 15 to 20 percent of patients die within one year of presentation of their limb ischemia, usually from the medical illnesses that predispose them to acute limb ischemia. 1,8,9 Most of the studies reported the risk factors associated with 30-days and 1-year mortality. The data on factors that contribute to in-hospital mortality is currently lacking.…”