Embolectomy

Embolectomy is the emergency surgical removal of emboli which are blocking blood circulation. It usually involves removal of thrombi (blood clots), and is then referred to as thrombectomy. Embolectomy is an emergency procedure often as the last resort because permanent occlusion of a significant blood flow to an organ leads to necrosis. Other involved therapeutic options are anticoagulation and thrombolysis.

Background knowledge

Emboli are aberrant masses of actual (which can be solid, aqueous or gas) that are agitated in the claret beck from one allotment of the apportionment to addition causing a blockage (occlusion) of a claret barge that leads to abridgement of oxygen accumulation (ischemia) and assuredly infarction of tissue after of the embolus.

The a lot of accepted blazon of emboli are a claret array generated by occlusion which has again torn off and is again transported in the claret beck (see embolism).

There are two areas area emboli can anatomy and accordingly impact:

Arterial emboli anatomy in the larboard ancillary of the affection or the capital arteries, they appulse in physique tissues but not the lungs, frequently in the academician and the baby argosy in the high and lower limbs

Venous emboli appear in veins (for archetype emboli which anatomy from abysmal venous occlusion or DVT) and these appulse in the lung (see pulmonary embolism).

Indications

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.1
Surgical or catheter embolectomy is normally performed in patients with pulmonary embolism (formed from venous embolisms). Embolectomy is used for patients with persisting shock despite supportive care and who have an absolute contraindication for thrombolytic therapy.2 And although other treatments have improved urgent surgical embolectomy or catheter embolectomy may be a life saving procedure in severe pulmonary embolism.3
Embolectomies are performed for arterial embolisms in acute limb ischemia. However there are also other options, such as catheter-directed thrombolysis and anticoagulation with observation.4
It can also be used for other ischemias due to embolism for example mesenteric ischemia and stroke.5

Methods

Catheter embolectomy

editBalloon embolectomy

Typically this is done by inserting a catheter with an inflatable airship absorbed to its tip into an artery, casual the catheter tip above the clot, inflating the balloon, and removing the array by abandoning the catheter. The catheter is alleged Fogarty, called afterwards its artist Thomas J. Fogarty.

Possible complications of airship embolectomy cover intimal lesions, which can advance to addition thrombosis.6 The barge may aswell be afflicted by a anatomization or breach or causing cholesterol array from atherosclerotic plaques.6

editAspiration embolectomy

Catheter embolectomy is aswell acclimated for aspiration embolectomy, area the array is removed by assimilation rather than blame with a balloon.7 It is a accelerated and able way of removing thrombi in thromboembolic occlusions of the limb arteries beneath the inguinal ligament,7 as in leg infarction.

editSurgical embolectomy

Surgical embolectomy is the simple surgical abatement of a array afterward cavity into a barge by accessible anaplasty on the artery

Outcome

Outcome of embolectomy varies with size and location of the embolus.citation needed
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.9