This document discusses the management of acute limb ischemia through thrombectomy or embolectomy. It provides details on: 1) Recognizing acute limb ischemia and starting heparin treatment while relieving pain and checking limb viability. 2) Performing an embolectomy by making a small arteriotomy above the bifurcation to insert a Fogarty catheter and remove the embolus. 3) Closing the arteriotomy with interrupted sutures and continuing heparin and warfarin treatment while monitoring for complications.

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