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At least 19 recordsLinked to original sources
PubMed1994

Performance of indirect embolectomy aided by a new developed flush-suction catheter system. Forty-seven experimental embolectomy procedures in test animals.

Embolectomy by means of the Fogarty catheter is the therapy of choice in the event of acute occlusions of limb arteries. However, less invasive catheter procedures have become established means to perform embolectomies lately. In order to improve the results after using the above mentioned methods, we have developed a new embolectomy procedure. The system applied consists of a flush-suction catheter as well as a high pressure pump. There is a jet-suction unit on the head of the tubular two-lumen catheter to gather thromboembolic material from the circumference of the head, to erode the collected material and evacuate it. The flushing pressure is generated by the pump. For the experimental testing of the system, the flush-suction embolectomy has been performed in 19 pigs after 47 artificial produced extremities embolism. Angiographically and angioscopically it could be proved that even older thrombotic material could be removed completely and without significant trauma of the vessel. At the pathologic investigation of the vessel in which embolectomy had been performed in no case an essential vessel-wall damage could be found. In almost each case the embolic material was removed completely. Only in 5 cases (10.6%) we have distal microembolism. Due to the experimental tests, the system turns out to be reliable as far as the technique is concerned. In addition, in the event of clinical application, the system allows the expectation of a reduction of the time interval between diagnosis and therapy, as well as a percutaneous application.

Angiography↗
PubMed1995

Theoretical considerations and in vitro results for the development of percutaneous transcatheter balloon embolectomy.

RATIONALE AND OBJECTIVES: To prove the feasibility of performing percutaneous transcatheter embolectomy using a funnel-shaped catheter tip and balloon embolectomy catheters. METHODS: A theoretical model is described to assess the influence of the diameter of an introductory device and coaxially introduced embolectomy catheter. A funnel-shaped catheter tip was attached to 7F, 8F, and 9F introductory sheaths. In vitro embolectomy of 5 g and 12 g thrombi was performed with 3F and 4F embolectomy catheters. RESULTS: The number of extractions required was significantly related to the ratio of the diameters of the sheaths and embolectomy catheter shafts. The combination of a 7F sheath with a 4F embolectomy catheter required the greatest number of extractions (8.4 +/- 1.7). The least number of extractions was needed for the combination of a 9F sheath with 4F and 3F embolectomy catheters (1.6 +/- 0.7 and 1.8 +/- 0.4, respectively). CONCLUSIONS: Our results indicate that percutaneous embolectomy with balloon embolectomy catheters is feasible. However, further research is necessary before the final catheter design is chosen.

Catheterization↗
PubMed1997

The impact of balloon embolectomy on the function and morphology of the endothelium.

PURPOSE: Intravascular interventions such as balloon embolectomy lead to endothelial injury. The extent and functional consequences of this endothelial injury are not known. METHODS: Segments of bovine carotid artery were equilibrated in a vasomotor perfusion apparatus (VPA). Smooth muscle function was determined by the contractile responses to 10(-5) M norepinephrine (NE). Endothelial function was evaluated by the extent of vasorelaxation to the subsequent addition of 10(-5) M acetylcholine (ACh). To determine the pattern of injury throughout the length of the vessel, strips of artery from along the vessel length were also evaluated in a muscle bath. Morphology was examined by scanning electron microscopy (SEM). RESULTS: No significant differences were noted in the contractile response to NE after embolectomy. Balloon embolectomy significantly decreased the relaxation response to ACh from 97 +/- 1% before embolectomy to 89 +/- 1% after embolectomy (n = 5 vessels, P < 0.01, ANOVA). In the muscle bath, the vasorelaxation of strips precontracted with NE was variable throughout the length of the vessel suggesting that endothelial injury was diffuse. The relaxation response to ACh was inhibited by L-NMMA. SEM revealed patchy areas of endothelial denudation. CONCLUSION: Embolectomy produces no change in smooth muscle function and partial injury to the endothelium in intact vessels. However, there remains sufficient endothelial function after balloon embolectomy to produce NO-dependent vasorelaxation and modulate vasomotor tone.

Acetylcholine↗
PubMed1994

The simple Fogarty embolectomy: an operation of the past?

We have found in reviewing our vascular cases that the Fogarty embolectomy is definitive treatment in only certain types of cases; in most it is an adjunct to more complex vascular surgery. In our cases, an embolectomy catheter was used as an integral part of the procedure in 130 (18%) cases. In 96 (74%) cases, an embolectomy alone was performed with a success rate of only 48% (46 cases). In 50 (52%) cases, the embolectomy was not adequate, requiring reoperation, a new bypass, or amputation within 7 to 10 days. Mortality rate for the series of 130 patients was 7.0%, and limb loss rate was 5.0%. The majority of cases (92) in this review were diagnosed with an acute exacerbation of diffuse peripheral vascular disease or a clotted graft, and it is in these patients that the success rate was so poor (17%) if embolectomy alone was performed. The population of patients presenting with suspected acute arterial insufficiency has changed over the past 30 years. Now it is the elderly who have an acute exacerbation of their peripheral vascular disease. It is this change in the population that has made the Simple Fogarty Embolectomy an operation of the past--mandating angiography, Fogarty embolectomy, and complex vascular reconstruction for limb salvage.

Aged↗
PubMed1993

Long-term experience with transvenous catheter pulmonary embolectomy.

PURPOSE: Massive pulmonary embolism (PE), defined by systemic hypotension and need for inotropic support, has a high mortality rate. Transvenous catheter pulmonary embolectomy performed with the patient receiving local anesthetic provides an expeditious alternative to lytic therapy or open embolectomy on cardiopulmonary bypass. METHODS: The indication for embolectomy in this series of 46 patients was hypotension despite inotropic support in all but four patients (91%); the latter sustained major embolism and were respirator dependent. In the first 10 patients treated from 1970 to 1974, a metal cup attached to a straight catheter was used. RESULTS: Hemodynamic improvement occurred in nine of 10 initial patients, but recurrent PE and a mortality rate of 50% prompted addition of a vena caval filter and directional control to the catheter. Subsequently 36 patients were treated with this combination from 1975 to 1992. Emboli were extracted in 76% (35 of 46) of the total series with a 30-day survival rate of 70% (32 of 46). Hemodynamic data showed an average reduction in mean pulmonary artery pressure of 8 mm Hg and a significant increase in mean cardiac output from 2.59 L/min to 4.47 L/min (p = 0.003) after embolectomy. Complications included wound hematoma (15%), pulmonary infarct (11%), recurrent deep venous thrombosis (6%), pleural effusion (4%), and myocardial infarction (4%). CONCLUSIONS: Successful embolectomy was most likely for categories of major PE (4 of 4, 100%) and massive PE (27 of 33, 82%) and least likely for chronic PE (5 of 9, 56%) (p < 0.03). Successful embolectomy also predicted long-term survival (p < 0.01), which was 89 months for the series (range 1 to 237 months). Catheter pulmonary embolectomy by surgeon and radiologist is of maximal benefit for major or massive PE but less likely to benefit patients with chronic recurrent PE.

Adolescent↗
PubMed1992

[Aggressive treatment of acute pulmonary embolism. 132 consecutive patients treated with heparin, streptokinase or embolectomy, 1975-1987].

During 1975-1987, 132 patients were treated for acute pulmonary embolism with heparin (n = 41), streptokinase (n = 52), or embolectomy (n = 39). In 1984, the indications for embolectomy were broadened to include all patients with central emboli, also those who were circulatory stable. The heparin-, streptokinase-, and embolectomy groups differed from each other as regards the degree of circulatory impairment (stable circulation/reversible shock/circulatory collapse: 68/32/0% versus 52/48/0% versus 16/56/28%, p less than 0.0001) and embolic score (20 for complete obstruction; 5.6 +/- 3.4 versus 8.7 +/- 2.8 versus 13.2 +/- 2.4, p less than 0.0001), but were comparable in terms of prognosis (30-day mortality/10-year survival +/- standard error: 7%/61 +/- 9% versus 13%/59 +/- 9% versus 18%/61 +/- 10%). Stable circulation, reversible shock, and circulatory collapse prior to embolectomy resulted in 30-day mortalities of 0%, 9%, and 45% respectively (p less than 0.01). During 1984-1987, no early or late deaths after embolectomy were observed in patients without circulatory collapse (n = 10). In comparable patients (embolic score greater than or equal to 9, symptom duration less than or equal to 7 days, no circulatory collapse), streptokinase treatment (n = 13) and embolectomy (n = 25) resulted in 10-year survival +/- standard error of 46 +/- 16% and 82 +/- 10% respectively (p less than 0.0001) and in an embolic score-reduction (score before minus score after treatment) of 5.7 +/- 2.3 and 10.5 +/- 2.9, respectively (p less than 0.0001). Embolectomy during extracorporeal circulation should be considered the treatment-of-choice in patients with acute central emboli.

Acute Disease↗
PubMed1992

Popliteal embolectomy: does it still have a role?

The failure of a femoral embolectomy presents a difficult problem. The role of popliteal embolectomy in the subsequent management is still not clear. A study of 12 patients who underwent a secondary popliteal embolectomy is reported. Nine of the 12 patients had successful results in terms of limb salvage. The question that has to be addressed is the role of popliteal embolectomy as opposed to thrombolysis. Recent studies tend to favour the latter approach. It is concluded that if an embolectomy catheter will not pass or will not clear the distal segment, the surgeon should consider intraoperative thrombolysis or popliteal embolectomy prior to embarking on a bypass procedure.

Amputation, Surgical↗
PubMed1986

Treatment of pulmonary embolism with full-dose heparin, streptokinase or embolectomy--results and indications.

The results of treatment of pulmonary embolism with heparin (n = 34), streptokinase (n = 28) or embolectomy (n = 25) are presented. The treatment groups represented different degrees of embolization with acute embolic scores (possible maximum: 20, mean +/- SD): 5 +/- 4, 9 +/- 3 and 13 +/- 3, respectively (p less than 0.0001). The post-treatment embolic score (mean +/- SD) for patients with acute massive central emboli (score greater than or equal to 9) was: 6 +/- 4 (n = 7) and 3 +/- 2 (n = 15) in the streptokinase and embolectomy groups, respectively, (p less than 0.01). The hospital mortality was 6% (n = 2), 21% (n = 6) and 20% (n = 5) in the heparin, streptokinase and embolectomy groups, respectively (p less than 0.05). The 5-year cumulative survival (+/- SE) was 68% +/- 10, 64% +/- 10 and 80% +/- 8, respectively (p: NS). The relative survival (hospital and late deaths, observed/expected) stratified according to acute embolic score showed the best results in the embolectomy group. Systolic pulmonary artery pressure greater than 60 mmHg was found in cases with a duration of symptoms greater than 7 days and/or with greater than or equal to 25 anamnestic recurrent embolic episodes before diagnosis, indicative of a gradual increase in pulmonary artery pressure and of partly organized non-lyseable emboli. Embolectomy carried a low risk of complications (8% with cerebral reduction). Streptokinase treatment was associated with serious complications (18% with cerebral reduction/fatal hemorrhage). Pulmonary embolectomy should be recommended in all cases with emboli in the main branches of the pulmonary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Experimental microsurgical embolectomy after middle cerebral artery embolization in the dog.

The effects of microsurgical embolectomy were investigated clinicopathophysiologically in 60 dogs after occlusion of the middle cerebral artery (MCA) trunk with a silicone cylinder embolus. One group of animals served as a control (non-embolectomized group), and in the other two groups the embolus was removed 3 or 6 hours after occlusion (3-hour or 6-hour embolectomy group). In the non-embolectomized animals, major neurological deficits with deep cerebral infarction were observed. Regional cerebral blood flow (CBF) in the basal ganglia decreased most prominently. Sensory evoked potentials also declined to about 50% of the control level 3 hours after embolization. In the 3-hour embolectomy group, mild neurological deficits with minimal infarctions were found. One hour after embolectomy, CBF was restored to the original level in all regions, and the sensory evoked potentials surpassed the control level. In the 6-hour embolectomy group, most animals exhibited major neurological deficits and severe brain swelling with hemorrhagic infarction. This study suggests that early microsurgical embolectomy of the MCA trunk restores blood flow in the perforating arteries and prevents deep cerebral infarction.

Animals↗
PubMed1989

Risk factors in selected patients undergoing femoral embolectomy.

Mortality rates after femoral embolectomy (FE) in patients with an acutely ischaemic leg vary from 20-40%. In the last 3 years we have adopted a policy of proceeding directly to femoral embolectomy in those patients with a strong clinical suspicion of an embolus. Where doubt exists about the diagnosis, arteriography is performed in combination with local streptokinase, balloon dilatation and/or reconstruction. In a prospective study between September 1984 and March 1987, 43 patients underwent femoral embolectomy with a limb salvage rate of 87%. The early mortality (within 30 days) was 16%, the late mortality was 26%, with a mean follow-up of 22 months. Of the seven patients who died within 30 days, one had a successful embolectomy but died from a cerebrovascular accident. The remaining six failed to improve clinically, all had poor backbleeding and no return of the peripheral pulses. None of these patients had an amputation. We recommend that femoral embolectomy be performed in those patients with a short history of ischaemia (less than 72 h), a risk factor suggesting an embolic source and no past history of intermittent claudication. If all three criteria are not met, arteriography should be performed with a view to fibrinolytic therapy or vascular reconstruction. In those patients who have had a failed embolectomy or where the circulation cannot be restored promptly, despite fibrinolytic therapy and/or distal reconstruction, early major amputation may be life-saving.

Adult↗
PubMed1999

The simple indicator for revascularization of acute middle cerebral artery occlusion using angiogram and ultra-early embolectomy.

BACKGROUND: The purpose of the study was: (1) to find a clinical indicator for revascularization of acute middle cerebral artery (MCA) occlusion using angiograms of 100 patients examined immediately after onset and treated medically and (2) to investigate 10 ultra-early MCA embolectomies. METHODS: Quantity of collateral circulation, based on time required for conduction of contrast media to the insular portion of the MCA from the anterior cerebral artery, MCA conduction time (MCT) was graded as: Grade 1: In the arterial phase, there was conduction not only to the insular portion of the MCA but also to proximal M2; Grade 2: Conduction to the insular portion was present in late arterial phase; Grade 3: Conduction was present in capillary phase; Grade 4: Conduction was present in venous phase; Grade 5: No conduction was seen. The results of embolectomy are discussed. RESULTS: MCT can predict the extent of resultant low-density area on computed tomographic scan. For Grades 3, 4, or 5, embolectomy could be considered superior to medical treatment, if the low-density area was localized in the basal ganglia or centrum semiovale after surgery. Consequently, embolectomy was effective in four cases recanalized within 6 hours of onset. Except for one Grade 5 case, the remaining nine cases showed neither lethal hemorrhagic infarction nor brain edema. Overall outcome was significantly better than cases treated medically (p < 0.05), but some cases did not recover from hemiparesis due to infarcts in the area of the lenticulostriate arteries. CONCLUSIONS: MCT helps to predict the applicability of revascularization of acute MCA occlusion. Efficacy of embolectomy depends on revascularization within 6 hours of onset. Even after complete MCA flow restoration, infarcts in the area of the lenticulostriate arteries cannot always be prevented.

Acute Disease↗
PubMed1995

[Pulmonary embolectomy in pulmonary embolism: surgery and endoluminal techniques].

Since Trendelenburg's first attempts in 1908, the techniques of embolectomy have progressed considerably. The reference method remains embolectomy under cardiopulmonary bypass, the development of which has reduced the operative mortality to 30-40% instead of 60% when embolectomy was performed without cardiopulmonary bypass. In the last few years, several techniques have been developed to perform embolectomy by percutaneous endoluminal methods. These procedures are difficult to initiate, little experimented in humans or still at the experimental stage in animals. Advances in the medical treatment of massive acute pulmonary embolism have reduced the indications of embolectomy which has become the exception reserved for the most seriously ill patients in whom the other methods are contraindicated or have failed.

Animals↗