Arterial embolectomy in the modern era.

The introduction of the Fogarty catheter heralded a new era in the management of patients with arterial embolism. In the 15 years from 1966 to 1980, the authors managed, operatively, 148 separate episodes of arterial embolization in 134 patients. Excluded from the series were patients who had visceral emboli and those who were managed nonoperatively. The emboli occurred in the upper extremities in 22 patients who had 24 embolic episodes and in the lower extremities in 112 patients who had 124 separate embolic episodes. The source of the embolus was the heart in 106 patients and in the remaining 28 patients a proximal aneurysm or atherosclerotic artery, a prosthetic graft or an unknown source. Most operative procedures were performed under local anesthesia using a transverse arteriotomy. The limb was saved in all 24 episodes of upper extremity embolism and in 115 (87%) of 132 lower limbs at risk (seven patients had emboli in both lower extremities simultaneously and one had emboli in an upper extremity and lower extremity simultaneously). The mortality for the 148 embolectomies was 20% an included all deaths occurring within 30 days after operation or during the same hospital admission. An analysis of our results indicates that embolectomy may not be successful when the delay between the occurrence of the embolus and its removal is excessively prolonged (more than 48 hours), when the patient is elderly and when the source of the embolus is unknown.