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Joel Arudchelvam MBBS, MD, MRCS, FCSSL
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EMBOLECTOMY Joel Arudchelvam Embolectomy history EMBOLECTOMY PROCEDURE
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Thrombo embolectomy
1.
THROMBO-EMBOLECTOMY Dr. JoelArudchelvam ConsultantVascular andTransplant
Surgeon Teaching HospitalAnuradhapura
2.
Acute limb Ischaemia
3.
Sites of embolus
4.
Acute limb Ischaemia Management
Recognize Start unfractionated heparin Loading dose 75 – 100 IU/Kg ( approximately 5000 IU ) Followed Infusion of heparin -18U/kg (approximately -1000U/hr) Pain relief Check theViability of the limb - note.
5.
How soon we
should remove
6.
Management Embolus Embolectomy
Thrombosis Thrombolysis Thrombectomy - surgical / endovascular Bypass
7.
Embolectomy history Direct
Indirect Handley - 1907 - suction Griffiths - 1938 - corksrew Key - 1936 - curetts Seen - 1963 - pliers Fogarty - 1963 - balloon catheter
8.
Embolectomy Local /
general anaesthesia prepare both (lower) limbs Proximal and distal control
9.
Embolectomy Transverse arteriotomy
– about 1cm proximal to bifurcation
10.
Embolecctomy catheters (Fogarty)
11.
Embolecctomy catheters (Fogarty) Sizes
2 to 7 2 – radial / ulnar 3 – brachial ¾ - Sup femoral 4/ 5 – iliac
12.
Embolecctomy catheters (Fogarty) FLUSH DISTAL
ENDWITH HEP SALINE
13.
CLOSURE OF ARTERIOTOMY
TRANSVERSE – INTERRUPTED. 6/0 PROLENE
14.
CLOSURE OF ARTERIOTOMY
TRANSVERSE – INTERRUPTED. 6/0 PROLENE 1 2 / 5 3/4
15.
POST EMBOLECTOMY KEEP
HEPARINISED WARFARIN LOOK FOR COMPLICATIONS
16.
THANKYOU
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