Fogarty balloon catheter thrombectomy

Fogarty with balloon catheter thrombectomy for the treatment of arterial embolism. Arterial embolism is an acute illness caused by a detached embolus that blocks an artery with a similar diameter. The vast majority of emboli are derived from the heart and are commonly found in rheumatic heart disease or arteriosclerotic heart disease with atrial fibrillation. Most embolizations are embedded in the lower extremity arteries at the end of the abdominal aorta and below. Sudden onset, the limbs at the distal end of the embolization site are severely painful due to acute ischemia. The disease progresses rapidly, and limb gangrene can occur very quickly. The prognosis is serious, so urgent treatment is needed. Since the first implementation of thrombectomy for acute arterial embolism in 1911, thrombectomy has been more than 80 years old. In the past, the total effective rate was about 77.6%. After 1963, the application of Fogarty balloon catheter simplified the operation, expanded the indications for surgery, and improved the efficiency (up to 94.6%). Treatment of diseases: arterial embolism Indication In principle, arterial embolization should be performed in addition to severe gangrene or embolization of the arterial branch, and the distal side has established a good collateral, which does not affect the blood donor. As long as the patient's general condition permits, the thrombectomy should be actively performed. The length of onset is closely related to the effect of embolectomy. The earlier the operation is performed, the better the effect is. It is generally considered that it is best to fight within 6-8 hours after onset. However, there are also cases in which patients undergoing thrombosis for several days or longer have achieved good results. Therefore, as long as the limb is still alive or gangrene, it is still necessary to perform a later bolting to save the limb. Contraindications The only contraindication for the implementation of thrombectomy is that the embolization time is too long and the limbs have had a wide range of gangrene. For some patients with poor general condition, especially those with arrhythmia and poor cardiac function, thrombectomy is of course dangerous, but embolization itself can cause further deterioration of heart disease, so except for some people who are in an endangered state and cannot withstand any blows. It is necessary to actively improve the general condition, prepare for surgery, and perform surgical thrombectomy. Preoperative preparation 1. Adopt various measures to improve the general condition of the patient, especially to improve the patient's heart function. 2. Heparin anticoagulant therapy. 50 mg was given before surgery, and 50 mg may be given during the operation according to the situation. Intravenous infusion of dextran-40 should be given before surgery. Surgical procedure Lower extremity arterial embolization can be performed by local anesthesia with Fogarty with a balloon catheter. Epidural anesthesia can also be used. Upper limb arterial thrombectomy can be anesthetized with local anesthesia or brachial plexus. The Fogarty balloon catheter is about 80cm long and the diameter varies from F2 to F7. The distal device has a small latex rubber capsule with a small hole communicating with the catheter, and a small amount of liquid can be injected from the end of the catheter to fill the capsule. 1. Femoral artery and its distal embolization Inguinal incision revealed total femoral, shallow femoral, deep femoral artery, bypassing the rubber band, respectively, first moderately tightened but not completely blocked blood flow. A longitudinal incision of 1 to 1.5 cm was made on the common femoral artery. The F3~F4Fogarty tube was inserted into the superficial femoral artery or deep femoral artery. The catheter was inserted as far as possible to the distal end, and then the saline was injected into the volume indicated by the wall. Press the catheter on the body surface and gradually pull out the catheter. The embolus can be removed from the arterial incision. The proximal extremity can also be inserted to remove the radial artery embolus. It is impossible for Fogarty catheter to enter every branch of arteries. Therefore, if 50,000 to 60,000 U urokinase is injected into the distal artery after thrombectomy, the effect may be better. Continuous sutures close the arterial incision, completely stop bleeding, and do not drain. 2. Transcatheter arterial thrombectomy After thrombectomy through the femoral artery, there should be blood flow from the distal end, such as poor outflow or X-ray angiography suspected that the distal end of the embolus can be removed through the radial artery. Incision of the knee joint, revealing the radial artery and its bifurcation, bypassing the image belt, cutting the radial artery into the F3~F2 Fogarty tube, inserting it into the distal end, injecting a little saline and pulling it upwards. If there is a thrombus, it can be cut in the incision. Take it out. 3. Thrombus removal through the bilateral femoral aorta bifurcation If the embolism is embedded in the bifurcation of the abdominal aorta, the bilateral femoral artery should be used for thrombectomy. Bilateral inguinal incision, showing bilateral common femoral artery, free 5 ~ 6cm, each side bypassed two rubber bands. First use the non-invasive blocker to block the right femoral artery, tighten the two rubber bands of the left femoral artery, cut a small mouth between 1 and 1.5 cm between the two, and insert the F5~F6Fogarty tube upwards to the fork. Level, slowly inject out the water in the catheter sac and remove the embolus. Use the same method to remove the contralateral embolus. Until both sides of the femoral artery beat recovery. complication 1. The catheter punctures the artery causing bleeding, so the cannula cannot be used too hard. 2. If the overfilled sac is pulled out, it will damage the intima of the artery or cause the atheromatous plaque to fall off again to form an embolus. Therefore, the choice of pipe diameter should be appropriate, and the bag should not be filled too large. 3. The catheter breaks and remains when pulled out, or the capsule separates from the catheter, leaving the wall of the capsule in the blood vessel. Therefore, the catheter must be carefully inspected before use. The catheter should generally be used once.