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Improved limb salvage after arterial embolectomy
Insights
An aggressive embolectomy approach for arterial emboli, regardless of symptom duration, yields an 80.9% limb salvage rate. Prompt treatment, even with delayed presentation, is crucial for functional limb outcomes.
Area of Science:
- Vascular Surgery
- Cardiology
- Interventional Radiology
Background:
- Arterial emboli pose a significant threat to limb viability.
- The heart is a common source of arterial emboli, often linked to myocardial infarction.
Purpose of the Study:
- To evaluate the outcomes of surgical embolectomy for arterial emboli.
- To determine the impact of symptom duration on limb salvage rates.
- To advocate for an aggressive surgical approach in managing arterial emboli.
Main Methods:
- Retrospective analysis of 122 patients with 135 arterial emboli treated between 1965 and 1977.
- Surgical embolectomy, primarily performed under local anesthesia.
- Intraoperative arteriography utilized in cases lacking distal pulses or clear revascularization.
Main Results:
- Hospital mortality was 10.6% (13 deaths).
- The corrected limb salvage rate was 80.9%, independent of symptom duration.
- 73% of patients achieved a functional limb at discharge or follow-up.
Conclusions:
- An aggressive surgical strategy for arterial emboli, including embolectomy, is recommended regardless of symptom duration.
- Embolectomy under local anesthesia is advocated after initial patient stabilization.
- Intraoperative arteriography is essential when revascularization is uncertain.
Abstract:
Between January 1965 and August 1977, 122 patients with 135 arterial emboli were treated on the Peripheral Vascular Service at the Ohio State University Hospital. The heart was the source of the embolus in 94 patients (77%), one-third of whom had experienced a myocardial infarct. Thirteen patients died after the operation, which in 102 patients (84%) consisted of embolectomy only, making the hospital mortality 10.6%. Fourteen patients (11.5%) required subsequent amputations during the same hospitalization or on a later admission. The corrected limb salvage rate of 80.9% was unrelated to the length of delay in presentation. Although only 70 patients (57.4%) had palpable distal pulses following operation, 89 (73%) had a functional limb at the time of discharge or on later follow-up. An aggressive approach to the patient with an arterial embolus, regardless of the duration of symptoms, is urged. Embolectomy under local anesthesia is advocated in all cases after prompt correction of fluid and electrolyte imbalance and stabilization of the underlying cardiac disorder, except in patients with frank gangrene and irreversible rigor. In the absence of distal pulses or obvious revascularization, an intraoperative arteriogram is mandatory.