Intra-operative arteriography in arterial embolectomy

In a retrospective study, 154 embolectomies in 135 patients with acute arterial occlusion were reviewed and the value of intraoperative arteriography studied. Included in the study were 69 embolectomies of the femoro-popliteal artery in 64 patients, and in 40 (58%) intra-operative arteriography was performed. Of these, 20 were done because of difficulty in passing the Fogarty catheter and/or absent backflow and 20 as a routine procedure where there was easy passage of the catheter and good backflow. In 29 embolectomies (42%) intra-operative arteriography was not performed because some surgeons, doubting the benefit of routine arteriography, did not use it. In 23 cases (58%) intra-operative arteriography led to an extension of the operation. Six out of 20 routine arteriograms (30%) showed incomplete clearance of the arterial tree, resulting in further embolectomy. The amputation rate was 17%, however in the group where routine arteriography was performed it was zero and significantly less than in the non-arteriogram group (23%). The use of intra-operative arteriography in arterial embolectomy surgery is recommended.