Acute ischemia of the upper extremity: long-term results following thrombembolectomy with the Fogarty catheter

Abstract.

Objective: In 1962, the procedure of arterial thrombembolectomy with the Fogarty catheter was established. Numerous studies have been published studying thrombembolectomies of the lower extremities. Limited information, however, is available following thrombembolectomy of the upper extremity after arterial occlusion. The aim of the present study, therefore, was to determine long-term results (3–5 years after thrombembolectomy) following thrombembolectomy of the upper extremity with the Fogarty catheter in a large retrospective clinical study. Design: In the present study, 251 patients were encountered. Over a period of 20 years, 283 thrombembolectomies with the Fogarty catheter were performed on the upper extremity at the surgical department of the University of Munich. Main outcome measurements: The appearance of local and general complications in the postoperative phase, as well as long-term results, were evaluated. Results: The results indicate that general complications – i.e., cardiac insufficiency, cerebral ischemia, etc. – occurred in 18 patients (7.2%). Local complications – i.e., wound infection, persistence of ischemia, or hematoma – were evident in 51 patients (20.3%). Re-occlusion following thrombembolectomy was found in 21 patients (8.8%). The affected extremity had to be amputated in five cases (2.0%), and 14 patients (5.6%) died during the postoperative phase. As a result of multimorbidity of the patients and average age at the time of surgery (73 years), 40% of the patients had died before the date of examination. Nonetheless, 111 patients of the 117 living patients showed no complaints or minor coldness and pain following heavy exercise. Conclusions: The results of the present study indicate that, in most cases, thrombembolectomy with the Fogarty catheter represents a successful surgical method for the acute treatment of arterial occlusion of the upper extremity.