| Vascular Procedure |
| Acute Limb Ischaemia |
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| Emergency Embolectomy |
- Can be performed under either general or local anaesthesia
- Display and control arteries with sling
- Transverse arteriotomy performed over common femoral artery
- Fogarty balloon embolectomy catheters used to retrieve thrombus
- If embolectomy fails - on-table angiogram and consider
Bypass graft or intraoperative thrombolysis
|
| Intra-Arterial Thrombolysis |
- Arteriogram and catheter advanced into thrombus
- Streptokinase 5000u/hr + heparin 250u/hr
- Alternative thrombolytic agents include urokinase or tissue plasminogen activator (TPA)
- Repeat arteriogram at 6 -12 hours
- Advance catheter and continue thrombolysis for 48 hours or until clot lysis
- Success 60-70% but needs careful case selection
- Not suitable if severe neuro-sensory deficit
- Thrombolysis can be accelerated by:
- Pulse spray through multiple side hole catheter
- Aspiration thrombectomy - debulking thrombus aspiration
- High dose over shorter time
- Complications
- Mortality of 1-2%
- Bleeding - CVA, retroperitoneal
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