[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.158.169.168. Please contact the publisher to request reinstatement.
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
May 1985

Arterial ThromboembolismA 20-Year Perspective

Author Affiliations

From the Peninsula Vascular Associates, San Mateo, Calif (Drs Tawes, Harris, Brown, Sydorak, Beare, and Scribner), and the Cardiovascular Surgical Group, Redwood City, Calif (Drs Shoor, Zimmerman, and Fogarty).

Arch Surg. 1985;120(5):595-599. doi:10.1001/archsurg.1985.01390290073012
Abstract

• Our experience with 739 patients with lower extremity thromboembolism since the advent of the balloon catheter has led us to several important observations: (1) As the etiology has shifted from rheumatic to atherosclerotic, we treat a more complex group of patients, one fourth of whom have severe, preexisting peripheral occlusive disease. (2) Early diagnosis and treatment is essential to decrease the mortality and morbidity, which has ranged about 25% ±10%. (3) Anticoagulation must be continued in the postoperative period, accepting wound hematomas as a fair "trade-off" to prevent recurrent embolus and distal thrombosis in areas inaccessible to the catheter. (4) Postoperative use of heparin "buys time" to further assess marginal results of embolectomy allowing arteriography and careful planning of secondary operations to assure not only a viable but a functional limb. There is little mention in the literature to emphasize this approach, which we think is essential for long-term salvage. Early in the series, patients were treated with heparin or embolectomy alone. There were 161 secondary operations In 135 patients following embolectomy consisting of repeated thromboembolectomy, popliteal exploration, sympathectomy, bypass graft(s), angioplasty, and endarterectomy. Additionally, 44 patients had a direct attack correcting the cardiac source of their embolism. Our overall mortality (12%) and limb salvage (95%) shows marked improvement compared with earlier reports. Therefore, we recommend combined embolectomy and heparin as the primary choice of therapy.

(Arch Surg 1985;120:595-599)

References
1.
Fogarty TJ, Cranley JJ, Krause RJ, et al:  A method for extraction of arterial emboli and thrombi . Surg Gynecol Obstet 1963;116:241-244.
2.
Blaisdell FW, Steele M, Allen RE:  Management of acute lower extremity arterial ischemia due to embolism and thrombosis . Surgery 1978; 84:822-834.
3.
Tawes RL Jr, Beare JP, Scribner RG, et al:  Value of postoperative heparin therapy in peripheral arterial thromboembolism . Am J Surg 1983; 146:213-215.Article
4.
Fisher RD, Fogarty TJ, Morrow AG:  Effect of temporary femoral artery occlusion on the femoral venous efflux in man . Surg Forum 1967;23: 188-189.
5.
Eriksson I, Holmberg JT:  Analysis of factors affecting limb salvage and mortality after embolectomy . Acta Chir Scand 1977;143:237-240.
6.
Hammarsten J, Holm J, Schersten T:  Positive and negative effects of anticoagulant treatment during and after arterial embolectomy . J Cardiovasc Surg 1978;19:373-379.
7.
Satiani B, Gross WS, Evans WE:  Improved limb salvage after arterial embolectomy . Ann Surg 1978;188:153-157.Article
8.
Lorentzen JE, Roder OC, Buchardt Hansen HJ:  Peripheral arterial embolism: A follow-up of 130 consecutive patients submitted to embolectomy . Acta Chir Scand 1980;502:111-116.
9.
Elliott JP Jr, Hageman JH, Szilagyi DE, et al:  Arterial embolization: Problems of source, multiplicity, recurrence, and delayed treatment . Surgery 1980;88:833-844.
10.
Campbell HC, Hubbard SG, Ernst CB:  Continuous heparin anticoagulation in patients with arteriosclerosis and arterial emboli . Surg Gynecol Obstet 1980;150:54-66.
11.
Kendrick J, Thompson BW, Read RC, et al:  Arterial embolectomy in the leg: Results in a referral hospital . Am J Surg 1981;142:739-743.Article
12.
Caruana JA, Guitierrez IZ, Anderson MN, et al:  Factors that affect the outcome of peripheral arterial embolism . Arch Surg 1981;116:423-425.Article
13.
Abbott WM, Maloney RD, McCabe CC, et al:  Arterial embolism: A 44-year perspective . Am J Surg 1982;143:460-464.Article
14.
Blaisdell FW, Lim RG, Amberg JR, et al:  Pulmonary microembolism: A cause of morbidity and death after major vascular surgery . Arch Surg 1966;93:776-786.Article
15.
Fisher RD, Fogarty TJ, Morrow AG:  Clinical and biochemical observations of the effect of transient femoral artery occlusion in man . Surgery 1970;68:323-328.
16.
Stallone RJ, Lim RC, Blaisdell FW:  The pathogenesis of the pulmonary changes following ischemia of the lower extremities . Ann Thorac Surg 1969;7:539-549.Article
17.
Haimovici H:  Arterial embolism, myoglobinuria, and renal tubular necrosis . Arch Surg 1970;100:639-645.Article
18.
Green RM, DeWeese JA, Rob CG:  Arterial embolectomy before and after the Fogarty catheter . Surgery 1975;77:24-33.
19.
Field T, Littody FN, Baker WH:  Immediate and long-term outcome of acute arterial occlusion of the extremities: The effect of added vascular reconstruction . Arch Surg 1982;117:1156-1160.Article
20.
Miller J, Ferguson L, Berce M, et al:  The role of femoral embolectomy in the management of limbs threatened by acute ischemia 'the cold limb.' J Vasc Surg 1983;24:437.
×