Embolektomie

Embolektomie is a surgical procedure to remove an embolus from a blood vessel in order to restore blood flow to the affected organ or limb. The operation is typically performed for arterial embolism causing acute limb ischemia, but can also be used for pulmonary embolism in selected patients who are hemodynamically compromised or when thrombolysis is contraindicated or unsuccessful.

Indications include acute limb ischemia due to arterial embolus, mesenteric or renal ischemia due to embolic occlusion, and, less commonly, life-threatening pulmonary embolism.

Procedures: The standard open approach uses a small arteriotomy at the occlusion site and a Fogarty embolectomy catheter to retrieve the embolus. If necessary, additional thrombectomy, patch angioplasty, or bypass may be performed. In percutaneous catheter-directed embolectomy, aspiration devices or mechanical thrombectomy may remove the embolus without open surgery. In pulmonary embolism, sternotomy with pulmonary embolectomy may be undertaken when less invasive methods fail or are not feasible.

Postoperative management includes anticoagulation to prevent recurrent embolism and identification of the embolic source (e.g., atrial fibrillation, valvular disease, endocarditis). Monitoring for reperfusion injury, compartment syndrome, and renal function is important.

Outcomes depend on etiology, promptness, and comorbidities; reperfusion can restore perfusion rapidly, but complications and re-occlusion can occur.

See also: Fogarty catheter, thrombectomy, acute limb ischemia, pulmonary embolism.