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Arterial embolectomy: a 34-year experience with 400 cases
Insights
Peripheral arterial embolectomy offers a high limb salvage rate of 90.5%. Prompt surgical intervention for arterial emboli, alongside heparin use, is crucial for optimal outcomes.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
Background:
- Peripheral arterial emboli are a significant cause of limb-threatening ischemia.
- Cardiac disease is a primary etiology for embolic events.
Purpose of the Study:
- To evaluate the long-term outcomes of peripheral arterial embolectomy.
- To identify factors influencing mortality and amputation rates.
Main Methods:
- Retrospective analysis of 400 peripheral arterial embolectomies in 326 patients over 34 years.
- Inclusion of data on operative mortality, amputation rates, and limb salvage.
- Assessment of embolic source, location, and time to intervention.
Main Results:
- Overall operative mortality was 11.0%, decreasing slightly to 10.0% after Fogarty catheter introduction.
- Amputation rate was 9.5%, resulting in a 90.5% limb salvage rate.
- Higher mortality associated with cardiac disease, aortic/iliac emboli, and recent myocardial infarction.
- Increased amputation rates linked to femoral/popliteal emboli and delayed treatment.
Conclusions:
- Prompt surgical management of peripheral arterial emboli is the preferred treatment.
- Early embolectomy and routine heparin administration contribute to low mortality and amputation rates.
- Underlying cardiac disease remains a major determinant of mortality.
Abstract:
A series of 400 peripheral arterial embolectomies performed in 326 patients over a 34-year period is presented. Operative mortality was 11.0 per cent overall and 10.0 per cent in patients after the introduction and use of Fogarty catheters. The plateau in mortality is related to the association with serious underlying cardiac disease. The amputation rate was 9.5 per cent, with a corresponding 90.5 per cent limb salvage rate. Cardiac disease was the most common cause of emboli and was responsible for the majority of deaths. Mortality was considerably higher in patients with aortic and iliac emboli and in patients with recent myocardial infarcts. Amputation rates were higher with femoral and popliteal emboli and correlated directly with the time delay from onset of symptoms to performance of embolectomy. Higher amputation rates in the second half of the series are related to liberalization of the indications for embolectomy. Prompt operative management of patients with peripheral arterial emboli remains the treatment of choice. Low mortality and amputation rates can be achieved with early embolectomy and routine use of heparin.