Management of neglected embolic occlusions in lower-limb arteries using arterial lavage

Fourteen patients (seven males and seven females aged between 8 months and 100 years) with embolic lower-limb arterial occlusions of 1 to 6 days' duration were treated at Assir Central Hospital, Abha, Saudi Arabia over a 27-month period. On admission, the limbs were ischaemic up to mid-thigh and peripheral pulses were absent. Doppler studies showed absence of blood flow. The anatomical block was localized by angiography and ultrasonography. Fogarty catheter embolectomy was performed in all patients followed by rapid positive-pressure lavage of the vascular tree with 4-61 Ringer's lactate solution containing mannitol in an attempt to remove free radicals. Three patients died; one transmetatarsal amputation was performed. The remaining 11 limbs were salvaged and these patients remain ambulatory 21 to 42 months after surgery.