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[Clinical aspects and treatment of acute arterial occlusion]
P Stirnemann1, A P Z'Brun, F Mahler
1Klinik für Thorax-, Herz- und Gefässchirurgie, Inselspital, Universität Bern.
Insights
Surgical interventions for acute lower extremity ischemia, caused by embolism or thrombosis, were compared. Catheter clot extraction for embolism showed lower mortality and amputation rates than surgical thrombotic occlusion.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
Context:
- Acute lower extremity ischemia presents a significant clinical challenge.
- Surgical interventions have historically been the primary treatment modality.
- Distinguishing between embolic and thrombotic causes is crucial for treatment selection.
Purpose:
- To compare the outcomes of surgical interventions for acute lower extremity ischemia due to embolism versus thrombosis.
- To evaluate the efficacy and safety of Fogarty-catheter clot extraction for embolic occlusion.
- To present a novel combined catheter intervention approach for thrombotic ischemia.
Summary:
- A study of 163 patients with acute lower extremity ischemia (113 embolic, 50 thrombotic) between 1982-1986.
- Fogarty-catheter clot extraction for embolism had lower mortality (10%) and amputation rates (8%) compared to surgical thrombotic occlusion (4% mortality, 16% amputation).
- A new approach combining catheter thrombolysis, aspiration, and balloon dilatation demonstrated good results in 70% of patients, especially with femoral thrombosis.
Impact:
- Highlights the superior outcomes of catheter-based embolectomy over surgical thrombectomy in acute limb ischemia.
- Introduces a promising minimally invasive approach for managing femoral thrombosis.
- Informs clinical decision-making for acute lower extremity ischemia treatment strategies.
Abstract:
163 patients underwent surgery for acute ischemia of the lower extremity between 1982 and 1986. Thrombosis was present in 50 cases and embolism in 113. Half of the patients with thrombosis showed signs of chronic occlusive disease of the arteries (intermittent claudication); in the latter group 2/3 of the patients had atrial fibrillation and 1/4 coronary heart disease. For embolism Fogarty-catheter clot extraction was performed, mainly under local anesthesia. This procedure is easy to perform even under emergency conditions (mortality 10%, amputation rate 8%). In contrast, the surgical procedure in thrombotic occlusion was more demanding (mortality 4%, amputation rate 16%) and in the case of severe ischemia had to be carried out on an emergency basis. In case of less severe ischemia the treatment consisted in initial heparinization and elective revascularization when the patient was stabilized. A new therapeutic approach involving local catheter thrombolysis, catheter clot aspiration and balloon dilatation is presented. The combined catheter intervention produces good results in 70% of patients, particularly those with femoral thrombosis.