Embolectomy

Embolectomy is the surgical or endovascular removal of an embolus from a blood vessel to restore blood flow. The procedure targets embolic occlusions—mobile clots or other embolic material—that obstruct arteries or veins in various territories. It is distinguished from thrombectomy, which usually refers to removing a thrombus that forms in situ, though the terms are often used interchangeably in practice.

Indications include acute arterial occlusion with limb-threatening ischemia, vascular salvage in mesenteric or renal arterial occlusions, and, less commonly, massive pulmonary embolism when thrombolysis is contraindicated or has failed.

Techniques include open surgical embolectomy, typically with a Fogarty balloon catheter through an arteriotomy, and percutaneous catheter-directed methods such as aspiration, mechanical thrombectomy, or rheolytic devices. Endovascular approaches may use adjunct imaging and distal protection. In some cases, a combination of surgical and endovascular steps is employed for complete revascularization.

Outcomes depend on occlusion location and time to reperfusion; limb salvage rates are higher when revascularization occurs within hours of onset. Complications include distal embolization, vessel injury, bleeding, reperfusion injury, and recurrent embolism due to underlying sources such as atrial fibrillation, endocarditis, or cardiac thrombus. Revascularization efforts may need to be accompanied by treatment of the embolic source.

Postoperative care typically includes systemic anticoagulation, management of the embolic source, and imaging follow-up to confirm patency. Embolectomy remains a life-saving option in selected patients when faster reperfusion is required or thrombolysis is unsuitable.