Embolectomy is the emergency

surgical Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

removal of

emboli An embolism is the lodging of an embolus, a blockage-causing piece of material, inside a blood vessel. The embolus may be a blood clot (thrombus), a fat globule ( fat embolism), a bubble of air or other gas ( gas embolism), amniotic fluid ( amn ...

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 Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated diges ...

. Other involved therapeutic options are

anticoagulation Anticoagulants, commonly known as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time. Some of them occur naturally in blood-eating animals such as leeches and mosquitoes, where the ...

and

thrombolysis Thrombolysis, also called fibrinolytic therapy, is the breakdown (lysis) of blood clots formed in blood vessels, using medication. It is used in ST elevation myocardial infarction, stroke, and in cases of severe venous thromboembolism (massive ...

Medical uses

Surgical embolectomy for massive pulmonary embolism (PE) has become a rare procedure and is often viewed as a last resort.

Thrombolytic therapy Thrombolysis, also called fibrinolytic therapy, is the breakdown (lysis) of blood clots formed in blood vessels, using medication. It is used in ST elevation myocardial infarction, stroke, and in cases of severe venous thromboembolism (massive p ...

has become the treatment of choice. 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. And although other treatments have improved urgent surgical embolectomy or catheter embolectomy may be a life saving procedure in severe pulmonary embolism. Embolectomies are performed as

limb-sparing techniques Limb-sparing techniques, also known as limb-saving or limb-salvage techniques, are performed in order to preserve the look and function of limbs. Limb-sparing techniques are used to preserve limbs affected by trauma, arthritis, cancers such as high- ...

for arterial embolisms in

acute limb ischemia Acute limb ischaemia (ALI) occurs when there is a sudden lack of blood flow to a limb. Acute limb ischaemia is caused by embolism or thrombosis, or rarely by dissection or trauma. Thrombosis is usually caused by peripheral vascular disease (athe ...

. However, there are also other options, such as

catheter-directed thrombolysis Thrombolysis, also called fibrinolytic therapy, is the breakdown (lysis) of blood clots formed in blood vessels, using medication. It is used in ST elevation myocardial infarction, stroke, and in cases of severe venous thromboembolism (massive ...

and

with observation. It can also be used for other ischemias due to embolism for example mesenteric ischemia and

stroke A stroke is a disease, medical condition in which poor cerebral circulation, blood flow to the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemorr ...

Methods

Catheter embolectomy

Balloon embolectomy

Typically this is done by inserting a

catheter In medicine, a catheter (/ˈkæθətər/) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgi ...

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. 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 Dissection (from Latin ' "to cut to pieces"; also called anatomization) is the dismembering of the body of a deceased animal or plant to study its anatomical structure. Autopsy is used in pathology and forensic medicine to determine the cause o ...

or rupture. The procedure may lead to

cholesterol embolism Cholesterol embolism occurs when cholesterol is released, usually from an atherosclerotic plaque, and travels as an embolus in the bloodstream to lodge (as an embolism) causing an obstruction in blood vessels further away. Most commonly this caus ...

from atherosclerotic plaques.

Aspiration embolectomy

Catheter embolectomy is also used for aspiration embolectomy, where the thrombus is removed by suction rather than pushing with a balloon. 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 A limb infarction is an area of tissue death of an arm or leg. It may cause ''skeletal muscle infarction'', avascular necrosis of bones, or necrosis of a part of or an entire limb. Signs and symptoms Early symptoms of an arterial embolism in the ...

Surgical embolectomy

Surgical embolectomy is the simple surgical removal of a clot following incision into a vessel by open surgery on the artery.MDGuidelines > Arterial Embolism And Thrombosis
From ''The Medical Disability Advisor'' by Presley Reed, MD. Retrieved on April 30, 2010

Outcome

Outcome of embolectomy varies with size and location of the embolus. 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.

Background

Emboli An embolism is the lodging of an embolus, a blockage-causing piece of material, inside a blood vessel. The embolus may be a blood clot (thrombus), a fat globule ( fat embolism), a bubble of air or other gas ( gas embolism), amniotic fluid ( amn ...

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 Occlusion may refer to: Health and fitness * Occlusion (dentistry), the manner in which the upper and lower teeth come together when the mouth is closed * Occlusion miliaria, a skin condition * Occlusive dressing, an air- and water-tight trauma ...

) of a

blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide awa ...

that leads to lack of oxygen supply (

ischemia Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems w ...

) and finally

infarction Infarction is tissue death ( necrosis) due to inadequate blood supply to the affected area. It may be caused by artery blockages, rupture, mechanical compression, or vasoconstriction. The resulting lesion is referred to as an infarct (from th ...

of tissue downstream of the embolus. The most common type of emboli are a blood clot generated by

thrombosis Thrombosis (from Ancient Greek "clotting") is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (th ...

which has then broken off and is then transported in the blood stream There are two areas where emboli can form and therefore impact: * Arterial emboli form in the left side of the

heart The heart is a muscular Organ (biology), organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as ca ...

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 Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enla ...

or DVT) and these impact in the lung (see

pulmonary embolism Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream ( embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathin ...

References

{{Vascular surgery procedures Interventional radiology Vascular procedures