Embolectomy

Surgical embolectomy for massive pulmonary embolism (PE) has become a rare procedure and is often viewed as a last resort. Thrombolytic therapy has become the treatment of choice.{{cite journal |doi= 10.1007/s00059-005-2701-x |title=Chirurgische Therapie der fulminanten Lungenembolie |trans-title=Surgical treatment for massive pulmonary embolism |language=de |journal=Herz |date=June 2005 |first=Ivan |last=Aleksic |author2=Kamler, Markus |author3=Herold, Ulf |author4= Massoudy, Parwis |author5= Jakob, Heinz Gunter |volume=30 |issue=4 |pages=269–273 |pmid=15965802|s2cid=44049003 }}

Surgical or catheter embolectomy is a procedure performed in patients with pulmonary embolism, which is a blockage of an artery in the lung caused by a blood clot. This procedure is typically used for patients who are in a critical condition, such as those who are experiencing persisting shock despite receiving supportive care, and who have an absolute contraindication for thrombolytic therapy. During the procedure, a catheter is inserted into the affected artery, and the clot is removed using a variety of techniques such as mechanical fragmentation or suction. However, it's important to note that there is a risk of complications such as bleeding, infection, and damage to the artery or surrounding tissue. This procedure is done under general anesthesia and with the help of imaging technology like angiography, and it's performed by interventional radiologists or cardiothoracic surgeons.{{cite journal |doi= 10.1016/j.lpm.2008.07.003 |pmid=18775637 |title=Embolies pulmonaires graves |trans-title=Massive pulmonary embolism |language=fr |journal=Presse Médicale |date=Oct 2008 |first=Olivier |last=Sanchez |author2=Planquette, Benjamin |author3=Wermert, Delphine |author4=Marie, Elisabeth |author5= Meyer, Guy |volume=37 |issue=10 |pages=1439–1446 }} And although other treatments have improved urgent surgical embolectomy or catheter embolectomy may be a life saving procedure in severe pulmonary embolism.{{cite journal |title=Acute pulmonary embolism advances in treatment |journal=Journal of the Association of Physicians of India |first2=BM |date=March 2008 |last2=Gupta |first1=Gupta, Brig |last1=Gupta, S |volume=56 |pages=185–191 |pmid=18697636}}

Embolectomies are performed as limb-sparing techniques for arterial embolisms in acute limb ischemia. However, there are also other options, such as catheter-directed thrombolysis and anticoagulation with observation.{{cite journal |doi= 10.1053/j.semvascsurg.2008.12.003 |title=Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene |journal=Seminars in Vascular Surgery |date=March 2009 |first=Robert |last=Rutherford |volume=22 |issue=1 |pages=5–9 |pmid=19298929}} It can also be used for other ischemias due to embolism for example mesenteric ischemia and stroke.{{cite journal |doi= 10.1016/S0140-6736(16)00163-X |title= Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials |journal=Lancet |date=Apr 2016 |first=Mayank |last=Goyal |pmid=26898852 |volume=387 |issue=10029 |pages=1723–1731 |s2cid= 34799180 }}{{cite journal |journal=Stroke |date=26 July 2017 |volume=48 |issue=9 |pages=2450–2456 |doi=10.1161/STROKEAHA.117.017320 |pmid=28747462 |title=Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis |author=Mistry EA|s2cid=3751956 |doi-access=free }}

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Typically this is done by inserting a catheter with an inflatable balloon attached to its tip into an artery, passing the catheter tip beyond the clot, inflating the balloon, and removing the clot by withdrawing the catheter. The catheter is called Fogarty, named after its inventor Thomas J. Fogarty.{{citation needed|date=March 2021}}

Possible complications of balloon embolectomy include intimal lesions, which can lead to another thrombosis.Kirurgiska åtgärder vid akut ischemi i nedre extremitet. (Google Translate: Surgical measures in acute ischemia of lower extremities.) Pekka Aho och Pirkka Vikatmaa. Finska Läkaresällskapets Handlingar (Finnish Medical Society Documents). No. 1, 2003 The vessel may also be affected by a dissection or rupture. The procedure may lead to cholesterol embolism from atherosclerotic plaques.

Catheter embolectomy is also used for aspiration embolectomy, where the thrombus is removed by suction rather than pushing with a balloon.{{cite journal |vauthors=Oğuzkurt L, Ozkan U, Gümüş B, Coşkun I, Koca N, Gülcan O |title=Percutaneous aspiration thrombectomy in the treatment of lower extremity thromboembolic occlusions |journal=Diagn Interv Radiol |volume=16 |issue=1 |pages=79–83 |date=March 2010 |pmid=20044798 |doi= 10.4261/1305-3825.DIR.2654-09.1 }} It is a rapid and effective way of removing thrombi in thromboembolic occlusions of the limb arteries below the inguinal ligament, as in leg infarction.

Surgical embolectomy is the simple surgical removal of a clot following incision into a vessel by open surgery on the artery.[http://www.mdguidelines.com/arterial-embolism-and-thrombosis MDGuidelines > Arterial Embolism And Thrombosis] {{Webarchive|url=https://web.archive.org/web/20180202063012/http://www.mdguidelines.com/arterial-embolism-and-thrombosis |date=2018-02-02 }} From The Medical Disability Advisor by Presley Reed, MD. Retrieved on April 30, 2010

Outcome of embolectomy varies with size and location of the embolus.{{Citation needed |date=December 2009}}

In pulmonary embolism recent data shows mortality as being approximately 20%. Although this is a high mortality, it may have life-saving potential in some instances.{{cite journal |doi= 10.1016/j.amjcard.2006.08.050 |title=Outcome of pulmonary embolectomy |journal=American Journal of Cardiology |date=2007-02-01 |first=Paul |last=Stein |author2=Alnas, Majd |author3=Beemath, Afzal |author4= Patel, Nikunj |volume=99 |issue=3 |pages=421–423 |pmid=17261411}}

Emboli are abnormal masses of material (which can be solid, liquid or gas) that are carried in the blood stream from one part of the circulation to another causing a blockage (occlusion) of a blood vessel that leads to lack of oxygen supply (ischemia) and finally infarction of tissue downstream of the embolus.{{citation needed|date=March 2021}}

The most common type of emboli are a blood clot generated by thrombosis which has then broken off and is then transported in the blood stream {{citation needed|date=January 2022}}

There are two areas where emboli can form and therefore impact:{{citation needed|date=March 2021}}

• Arterial emboli form in the left side of the heart or the main arteries, they impact in body tissues but not the lungs, commonly in the brain and the small vessels in the upper and lower limbs
• Venous emboli arise in veins (for example emboli which form from deep venous thrombosis or DVT) and these impact in the lung (see pulmonary embolism).

• Interventional radiology
• Thrombolysis
• Heparin and other anticoagulants

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{{Vascular surgery procedures}}

Category:Interventional radiology

Category:Vascular procedures