Embolectomy
Encyclopedia
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
.
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.
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 (see embolism
).
There are two areas where emboli can form and therefore impact:
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 for arterial embolisms in acute limb ischemia. However there are also other options, such as catheter-directed thrombolysis and anticoagulation with observation.
It can also be used for other ischemias due to embolism for example mesenteric ischemia and stroke
.
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. The vessel may also be affected by a dissection
or rupture or causing cholesterol embolism
from atherosclerotic plaques.
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.
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
removal of emboli
Embolus
An embolus is any detached, itinerant intravascular mass carried by circulation, which is capable of clogging arterial capillary beds at a site distant from its point of origin.By contrast there are non-traveling blockages that develop locally from vascular trauma or...
which are blocking blood circulation. It usually involves removal of thrombi
Thrombus
A thrombus , or blood clot, is the final product of the blood coagulation step in hemostasis. It is achieved via the aggregation of platelets that form a platelet plug, and the activation of the humoral coagulation system...
(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
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
. Other involved therapeutic options are anticoagulation and thrombolysis
Thrombolysis
Thrombolysis is the breakdown of blood clots by pharmacological means. It is colloquially referred to as clot busting for this reason...
.
Background knowledge
EmboliEmbolus
An embolus is any detached, itinerant intravascular mass carried by circulation, which is capable of clogging arterial capillary beds at a site distant from its point of origin.By contrast there are non-traveling blockages that develop locally from vascular trauma or...
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
Vascular occlusion
Vascular occlusion is a sudden blockage of a blood vessel, usually with a clot. It differs from thrombosis in that it can be used to describe any form of blockage, not just one formed by a clot. When it occurs in a major vein, it can, in some cases, cause deep vein thrombosis. The condition is...
) of a blood vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
that leads to lack of oxygen supply (ischemia
Ischemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
) and finally infarction
Infarction
In medicine, infarction refers to tissue death that is caused by a local lack of oxygen due to obstruction of the tissue's blood supply. The resulting lesion is referred to as an infarct.-Causes:...
of tissue
Tissue (biology)
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...
downstream of the embolus.
The most common type of emboli are a blood clot generated by thrombosis
Thrombosis
Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss...
which has then broken off and is then transported in the blood stream (see embolism
Embolism
In medicine, an embolism is the event of lodging of an embolus into a narrow capillary vessel of an arterial bed which causes a blockage in a distant part of the body.Embolization is...
).
There are two areas where emboli can form and therefore impact:
- Arterial emboli form in the left side of the heartHeartThe heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
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 embolismPulmonary embolismPulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
).
Indications
Surgical embolectomy for massive pulmonary embolism (PE) has become a rare procedure and is often viewed as a last resort. Thrombolytic therapyThrombolysis
Thrombolysis is the breakdown of blood clots by pharmacological means. It is colloquially referred to as clot busting for this reason...
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 for arterial embolisms in acute limb ischemia. However there are also other options, such as catheter-directed thrombolysis and anticoagulation with observation.
It can also be used for other ischemias due to embolism for example mesenteric ischemia and stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
.
Balloon embolectomy
Typically this is done by inserting a catheterCatheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
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
Thomas J. Fogarty
Dr. Thomas J. Fogarty is an American surgeon and inventor of the embolectomy catheter. Before his invention the success rate for removing an embolus, or blood clot, was forty to fifty percent. In 1963, Dr...
.
Possible complications of balloon embolectomy include intimal lesions, which can lead to another thrombosis. The vessel may also be affected by a dissection
Dissection (medical)
In medical pathology, dissection refers to a tear within the wall of a blood vessel, which allows blood to separate the wall layers, creating a pseudoaneurysm.- Types :Examples include:*Aortic dissection...
or rupture or causing cholesterol embolism
Cholesterol embolism
Cholesterol embolism occurs when cholesterol is released, usually from an atherosclerotic plaque, and travels along with the bloodsteam to other places in the body, where it obstructs blood vessels...
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.Surgical embolectomy
Surgical embolectomy is the simple surgical removal of a clot following incision into a vessel by open surgery on the artery.Outcome
Outcome of embolectomy varies with size and location of the embolous.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.
External links
- An article on femoral embolectomy (from netdoctor.co.uk) reviewed by a consultant transplant and general surgeon
- A dictionary definition of Embolectomy (from Princeton University's WordNet)