Complications Encountered During Arterial Embolectomy with the Fogarty Balloon Catheter

Abstract

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.

Direct percutaneous embolization of a postembolectomy pseudoaneurysm

“…Most of these aneurysms are clinically silent and are recognized incidentally during completion or follow-up arteriography [13]. They are apparently caused by inadvertent disruption of the arterial wall from overdilation by the embolectomy balloon or by direct cath- eter perforation [14,15]. In the present situation, pseudoaneurysm formation most likely resulted from damage to the occluded posterior tibial artery by the embolectomy catheter.…”

“…Pseudoaneurysms are a rare but recognized complication of Fogarty-balloon thromboembolectomy [13][14][15]. Most of these aneurysms are clinically silent and are recognized incidentally during completion or follow-up arteriography [13].…”

Cardiac tamponade and coronary artery pseudoaneurysm after brachial arterial embolectomy, possible role for an aberrant origin of the right coronary artery

“…It is a convenient, minimally invasive, and safe method, although complications related to balloon inflation, such as arterial wall dissection, rupture, vessel obstruction, embolic events including stroke, and formation of arteriovenous fistulas, have been reported. 3 , 4 , 5…”

A systematic approach to emergent breast free flap takeback: Clinical outcomes, algorithm, and review of the literature

“…It can cause denudation of the endothelium, leading to exposure of thrombogenic subendothelium and loss of vasodilation . Other potential complications include arterial perforation from overinflation, tip separation, intimal dissection, and catheter rupture inside a blood vessel …”