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Embolectomy

An embolectomy is a surgical or interventional procedure to remove an embolus—a blood clot or other material that has traveled through the bloodstream from a distant site and lodged in a blood vessel, obstructing blood flow and potentially causing ischemia.^[1]^[2] This emergency intervention aims to rapidly restore circulation to affected tissues or organs, preventing complications such as tissue necrosis, organ failure, or death.^[1] Emboli commonly originate from the heart (e.g., due to atrial fibrillation or endocarditis) or deep veins of the legs, traveling to sites like the arteries of the limbs, lungs (causing pulmonary embolism), brain (causing stroke), or intestines.^[1] When an embolus lodges, it blocks blood flow, leading to acute ischemia; if untreated, this can result in irreversible tissue damage or infarction due to lack of oxygen and nutrients. Embolectomy is indicated primarily for acute cases where timely reperfusion is critical to salvage limbs or organs, such as in limb-threatening arterial embolism or massive pulmonary embolism with instability.^[1] The procedure may involve open surgical techniques or minimally invasive catheter-based approaches, selected based on embolus location, size, and patient factors.^[2]^[3] While effective in improving outcomes when performed promptly, embolectomy carries risks including bleeding and vessel injury, and requires postoperative anticoagulation to prevent recurrence.^[2] Advances in endovascular devices have made these interventions more accessible and less invasive.^[3]

Introduction and Background

Definition and Overview

Embolectomy is an emergency medical procedure involving the interventional or surgical removal of an embolus—a foreign material, typically a blood clot, that has traveled through the bloodstream and lodged in a blood vessel, obstructing blood flow and potentially causing tissue damage.^[4] This intervention aims to rapidly restore circulation to prevent ischemia or infarction in affected organs.^[4] Emboli can include thromboemboli (blood clots), fat globules, or air bubbles, though thromboemboli are the most common.^[5] Unlike thrombectomy, which targets a thrombus formed in situ at the site of obstruction, embolectomy specifically addresses an embolus that has migrated from a distant origin, such as from the deep veins of the legs.^[5] It also differs from thrombolysis, a pharmacological approach that uses medications to dissolve the clot rather than physically extracting it, thereby avoiding risks associated with drug-induced bleeding.^[4] The procedure is commonly performed in arterial sites such as the limbs, brain, or mesenteric arteries, as well as venous sites like the pulmonary arteries, where blockages can lead to severe complications including limb loss, stroke, or respiratory failure.^[5] In acute settings, embolectomy serves as a critical intervention to salvage tissue viability and stabilize hemodynamics when conservative measures fail.^[4]

Pathophysiology of Relevant Embolisms

Emboli relevant to embolectomy can originate from various sources, including deep vein thrombosis (DVT) in the lower extremities for pulmonary embolism, and cardiac thrombi for arterial embolism.^[6] For venous emboli, this process is governed by Virchow's triad, which encompasses three key factors: venous stasis, hypercoagulability, and endothelial injury.^[7] Venous stasis occurs due to reduced blood flow, often from immobility or compression; hypercoagulability arises from genetic predispositions, malignancies, or inflammatory states; and endothelial injury results from trauma, surgery, or vascular damage.^[8] These elements interact to initiate thrombus formation on the venous wall, which can propagate and become dislodged as an embolus.^[9] Once formed, emboli migrate through specific vascular pathways depending on their origin. Venous emboli from lower extremity DVT travel via the inferior vena cava to the right side of the heart and into the pulmonary arteries, resulting in pulmonary embolism (PE).^[10] In contrast, arterial emboli typically originate in the heart, such as thrombi forming in the left atrial appendage during atrial fibrillation, where irregular contractions promote blood stagnation and clot development; these emboli then enter the systemic circulation and lodge in peripheral arteries.^[11] This migration disrupts normal blood flow, leading to acute vascular occlusion.^[12] Occlusion by an embolus causes downstream ischemia by blocking arterial perfusion, which deprives tissues of oxygen and nutrients, potentially progressing to infarction if prolonged.^[13] In massive PE, extensive pulmonary arterial blockage increases pulmonary vascular resistance, imposing acute strain on the right ventricle through pressure overload, which can lead to right ventricular dilation, dysfunction, and hemodynamic instability.^[14] Relevant embolus types include thromboemboli, the most common form consisting of blood clots, and paradoxical emboli, where a venous thrombus crosses a right-to-left shunt such as a patent foramen ovale into the arterial circulation, bypassing the lungs.^[15]

Indications and Patient Selection

Primary Medical Indications

Embolectomy is primarily indicated in cases of acute limb ischemia (ALI) caused by arterial embolism, particularly in Rutherford classification stages I and IIa, where the limb is viable or marginally threatened and salvageable with prompt intervention. In these scenarios, surgical or catheter-based embolectomy serves as a first-line revascularization option when the occlusion is embolic in nature, such as from cardiac sources, and is especially recommended if thrombolysis has failed or is contraindicated due to risks like recent surgery or bleeding disorders.^[16] For pulmonary embolism (PE), embolectomy is recommended as a salvage therapy in high-risk cases characterized by hemodynamic instability, defined as systolic blood pressure less than 90 mmHg for at least 15 minutes or requiring inotropic support, particularly when systemic thrombolysis is contraindicated or ineffective. In intermediate-risk (submassive) PE with right ventricular dysfunction evidenced by imaging such as echocardiography or CT, catheter-directed embolectomy may be considered if the patient deteriorates despite anticoagulation, aligning with evidence-based guidelines that position it as an alternative to thrombolysis in high-risk patients.^[17]^[18] Embolectomy is also indicated for acute mesenteric ischemia due to superior mesenteric artery embolism, where prompt surgical embolectomy, often combined with angioplasty, is a definitive treatment to prevent bowel necrosis in patients with confirmed embolic occlusion via CT angiography. In select neurovascular cases of acute ischemic stroke from large vessel occlusion, such as the internal carotid or proximal middle cerebral artery, mechanical thrombectomy (a form of embolectomy) is recommended for eligible patients within 6 to 24 hours of symptom onset if imaging confirms salvageable brain tissue. For acute renal artery occlusion presenting with sudden flank pain, oliguria, or rising creatinine in the setting of embolism, endovascular or surgical embolectomy is indicated to preserve renal function when the kidney remains viable, typically as an alternative to anticoagulation alone in hemodynamically stable patients.^[19]^[20]^[21]

Contraindications and Risk Assessment

Embolectomy, whether surgical or catheter-based, carries specific absolute contraindications that preclude its performance due to unacceptable risks of harm. These include active or uncontrolled bleeding from any site, such as gastrointestinal hemorrhage or recent surgical wounds, as intervention could exacerbate hemorrhage.^[22]^[23] Recent major surgery or trauma within the past 10 days is a relative contraindication, particularly for procedures involving thrombolysis or high-dose anticoagulation, but mechanical embolectomy may still be considered as an alternative in life-threatening cases where thrombolysis is contraindicated.^[23] Active or recent peptic ulcer disease is a relative contraindication due to increased bleeding risk with procedural anticoagulation, with active bleeding considered absolute.^[23] Relative contraindications are conditions where embolectomy may be feasible but require careful weighing of benefits against potential complications. Advanced age, particularly over 75 years, is a relative contraindication due to increased frailty and perioperative mortality risk in both pulmonary embolism (PE) and acute limb ischemia (ALI) cases.^[22] Comorbidities such as severe chronic obstructive pulmonary disease (COPD) in PE patients pose relative risks by complicating respiratory management and right ventricular strain during procedure.^[22] For catheter-based approaches, small vessel size or anatomical variants limiting access, such as in peripheral arteries for ALI, serve as relative contraindications that may necessitate alternative surgical techniques.^[23] Preoperative risk assessment employs validated tools to stratify patients and guide embolectomy suitability. For PE, the Pulmonary Embolism Severity Index (PESI) or its simplified version (sPESI) evaluates 30-day mortality risk based on age, comorbidities, vital signs, and laboratory markers, identifying intermediate- to high-risk patients who may benefit from embolectomy when systemic therapies are contraindicated.^[24]^[25] In ALI, the ankle-brachial index (ABI) assesses perfusion deficits, while angiography confirms occlusion extent and vessel patency for procedural planning.^[23] Multidisciplinary evaluation involving vascular surgeons, interventional radiologists, and cardiologists is essential to integrate these tools with clinical judgment, ensuring embolectomy is reserved for cases where benefits outweigh procedural risks.^[26] Patient selection emphasizes timely intervention and confirmatory imaging to optimize outcomes. For ALI, revascularization within 6-8 hours of symptom onset is critical for limb salvage in immediately threatened limbs (Rutherford class IIb), as delays beyond this window increase irreversible tissue loss.^[23] Imaging confirmation via CT angiography for central emboli in PE or duplex ultrasound for peripheral ALI ensures precise localization and viability assessment prior to embolectomy.^[22]^[23]

Procedural Methods

Catheter-Based Embolectomy

Catheter-based embolectomy represents a minimally invasive endovascular approach to remove emboli from vascular beds, primarily targeting pulmonary embolism (PE) and peripheral arterial occlusions as an alternative to open surgery. These techniques utilize image-guided catheter navigation to access and extract clot material, offering reduced recovery time and lower procedural risks compared to traditional methods. Performed in catheterization laboratories, they are indicated for acute or subacute emboli causing hemodynamic instability or limb-threatening ischemia.^[27]^[28] Access is typically achieved through percutaneous puncture of the femoral or radial artery or vein, guided by fluoroscopy to ensure precise vessel entry and minimize complications. For pulmonary applications, venous access via the common femoral or jugular vein is common, using sheaths sized 7–24 Fr depending on the device, with a guidewire advanced to the pulmonary arteries for catheter positioning. In peripheral arterial cases, such as acute limb ischemia (ALI), contralateral femoral or ipsilateral antegrade access is preferred, often with ultrasound assistance for micropuncture and sheath insertion up to 8 Fr. Pre-procedural angiography confirms embolus location, and systemic heparin (3000–5000 UI) is administered to prevent further thrombosis.^[29]^[30]^[31] Balloon embolectomy employs devices like the Fogarty catheter to mechanically dislodge and extract emboli through controlled inflation and deflation. In peripheral arteries, a 2–5 Fr Fogarty catheter is inserted via femoral arteriotomy or sheath, advanced past the occlusion under fluoroscopy, inflated with saline to engage the embolus, and gently withdrawn to retrieve the clot until back-bleeding confirms clearance. This technique achieves technical success in approximately 90% of ALI cases when combined with imaging guidance. For pulmonary emboli, balloon methods are less frequent due to vessel fragility but may involve similar Fogarty-style catheters in proximal branches to fragment and aspirate thrombus.^[31]^[32] Aspiration embolectomy uses vacuum-based systems to directly suction clot material, particularly effective for soft, fresh emboli in both pulmonary and peripheral settings. The Penumbra Indigo system, for instance, features catheters (3–8 Fr for peripheral, up to 16 Fr for pulmonary) connected to a continuous aspiration engine generating 28.5 mm Hg negative pressure, allowing multiple passes through the occlusion to remove thrombus while preserving blood flow. Procedure steps include advancing the catheter to the embolus under angiography, activating aspiration, and repeating until flow is restored, often with adjunctive low-dose thrombolytics if residual clot persists. In pulmonary PE, devices like AngioVac provide large-bore (22–26 Fr) aspiration with veno-venous bypass, reducing right ventricular/left ventricular (RV/LV) ratio by approximately 25%. For peripheral ALI, this approach yields post-procedural ankle-brachial indices (ABIs) around 0.94 and avoids amputation in most cases.^[30]^[33]^[28]^[34] Mechanical thrombectomy variants, including stent-retrievers and flow-truncation devices, are suited for larger or adherent clots, with adaptations for pulmonary and peripheral applications. Stent-retrievers like the FlowTriever system deploy nitinol disks (via 16–24 Fr sheaths) into the pulmonary arteries or peripheral vessels to trap and retract emboli under aspiration, achieving RV/LV ratio reductions of 0.38 in PE and restoring distal perfusion in ALI. Flow-truncation techniques, such as rheolytic systems (e.g., AngioJet), generate high-velocity saline jets to fragment thrombus via the Bernoulli principle, followed by aspiration at -600 mm Hg, often in peripheral arteries where they macerate clots without systemic thrombolysis. These methods are performed in steps: catheter navigation to the site, device deployment and activation for 1–5 minutes per pass, and confirmatory angiography, with success rates exceeding 95% in proximal occlusions. Recent trials, such as the PEERLESS study (2024), have demonstrated that large-bore mechanical thrombectomy (e.g., FlowTriever) achieves similar hemodynamic improvements to catheter-directed thrombolysis in intermediate-risk PE but with lower rates of major bleeding (1.7% vs. 6.7%).^[27]^[34]^[35]^[36] Following catheter-based embolectomy, anticoagulation is promptly initiated to prevent re-embolization, typically with unfractionated heparin (200–300 units/hour) transitioning to low-molecular-weight heparin (1 mg/kg every 12 hours) or direct oral anticoagulants like rivaroxaban. Imaging verification, such as repeat pulmonary angiography, CT angiography, or echocardiography, confirms flow restoration and assesses RV function, with procedures often allowing same-day extubation and hospital stays of 2–3 days. Monitoring for reperfusion injury or bleeding is essential, guiding dual antiplatelet therapy in select peripheral cases.^[29]^[35]^[37]

Surgical Embolectomy

Surgical embolectomy involves open surgical intervention to directly extract emboli from arterial sites, reserved for cases where less invasive catheter-based methods are insufficient or contraindicated. Indications include proximal or large emboli, such as aortic saddle emboli that compromise bilateral lower extremity perfusion, where prompt surgical removal is essential to restore flow and prevent irreversible ischemia. It is also indicated following failed catheter-directed attempts or in patients with concomitant cardiac conditions, such as massive pulmonary embolism (PE) causing hemodynamic instability despite initial therapies. In peripheral arterial occlusions, surgery is preferred for acute limb-threatening ischemia due to emboli originating from cardiac sources like atrial fibrillation. Operative techniques vary by anatomical location. For peripheral vessels, such as the femoral or iliac arteries, the procedure typically employs arteriotomy to access the affected site, allowing direct visualization and extraction of the clot. In contrast, pulmonary embolectomy requires a median sternotomy to expose the pulmonary artery, often performed under cardiopulmonary bypass to maintain circulation during intervention. For aortic saddle emboli, bilateral transfemoral embolectomy is commonly utilized, involving incisions in the common femoral arteries to pass catheters or instruments proximally for clot dislodgement and retrieval, though direct transabdominal aortotomy may be necessary in select cases. The surgical steps generally include vessel exposure through appropriate incisions, followed by proximal and distal clamping to isolate the embolus and minimize distal embolization. The clot is then removed using forceps, suction, or balloon embolectomy catheters like the Fogarty device, ensuring complete extraction to restore patency. Vessel repair follows, involving primary closure, patching with autologous or synthetic material, or interposition grafting if significant damage or resection is required. General anesthesia is standard, with extracorporeal membrane oxygenation (ECMO) employed as perioperative support in high-risk PE cases to stabilize hemodynamics. A specific variant is the modified Trendelenburg operation for pulmonary embolectomy, which historically involved temporary pulmonary artery occlusion without bypass but has evolved to incorporate cardiopulmonary bypass for safer thrombus evacuation from the main pulmonary trunk and branches. Catheter-based approaches serve as less invasive first-line options for many emboli, but surgical embolectomy remains critical for inaccessible or massive thrombi.

Outcomes and Complications

Efficacy and Success Metrics

Embolectomy demonstrates high efficacy in restoring perfusion and stabilizing patients with acute limb ischemia (ALI), with technical success rates for mechanical thrombectomy reaching 97.4% and clinical success rates of 95.4% in recent multicenter data from 2021.^[38] In ALI, revascularization success typically ranges from 80% to 97%, enabling rapid limb reperfusion and contributing to 30-day limb salvage rates of approximately 95%.^[39]^[40] These outcomes are particularly favorable in endovascular approaches compared to open surgery, where combined 30-day mortality and major amputation rates are reduced to 15% with percutaneous techniques.^[41] For massive pulmonary embolism (PE), embolectomy achieves hemodynamic stabilization in 70% to 93% of high-risk cases, depending on the method, with catheter-directed approaches showing 93.3% stabilization within 24 hours in patients with right ventricular dysfunction.^[42] Clinical success, defined as avoidance of hemodynamic decompensation or major adverse events, stands at 81.3% for catheter-directed thrombolysis-integrated embolectomy in high-risk PE, per a 2018 meta-analysis.^[43] Surgical embolectomy yields in-hospital mortality rates of 19.8% to 22.2% in national cohorts, representing a reduction from the 30% to 50% mortality observed with medical therapy alone in hemodynamically unstable patients.^[44]^[45] This mortality benefit is evident against conservative management, where untreated high-risk PE carries over 25% in-hospital death risk.^[46] Efficacy is influenced by embolus age, with interventions most effective for clots less than 48 hours old, as older thrombi (beyond 5-8 days) increase embolization risk during mechanical removal and reduce complete extraction rates.^[47] Patient comorbidities, such as advanced age or cardiopulmonary disease, further modulate outcomes, with poorer results in those over 65 years or with severe right ventricular strain. Compared to thrombolysis, embolectomy provides faster revascularization (often within hours) but carries a higher risk of reocclusion if residual clot fragments embolize distally.^[45] Long-term metrics underscore embolectomy's impact, including 90.1% limb salvage at one year in ALI cohorts treated endovascularly, significantly lowering amputation rates versus medical therapy alone (from 20-30% to under 10%).^[39] In PE, surgical embolectomy is associated with lower rates of recurrent events (2.8% at five years) and survival rates of 76% compared to thrombolysis.^[48]

Risks, Complications, and Management

Embolectomy procedures, whether catheter-based or surgical, carry risks of bleeding and hematoma formation at access sites, with incidences ranging from 1% to 10% depending on the approach and patient factors such as anticoagulation status.^[49] Vessel perforation or dissection occurs in approximately 1% to 2.5% of cases, particularly during catheter manipulation in fragile vasculature, while distal embolization affects 1% to 5% of peripheral interventions and up to 17% in more complex lower extremity procedures.^[33]^[50]^[51] Catheter-based embolectomy is associated with method-specific risks including contrast-induced nephropathy, reported in up to 10% of cases involving rheolytic devices due to hemolysis and hemoglobinuria, and arrhythmias such as bradycardia from adenosine release during thrombectomy.^[33] Surgical embolectomy, often requiring cardiopulmonary bypass for pulmonary cases, carries risks of infection at the surgical site (incidence around 7% for wound complications) and stroke, occurring in 5.4% of pulmonary embolectomy patients.^[52]^[53] Rare but severe complications include myocardial infarction from hemodynamic instability, renal failure necessitating dialysis (up to 16% in surgical pulmonary series), and overall mortality, which has declined in modern series to approximately 22% for surgical pulmonary embolectomy and 0.8% to 3.6% at 30 days for mechanical thrombectomy in high-risk pulmonary embolism, reflecting improved techniques and patient selection.^[53]^[52]^[33] Recent meta-analyses from 2021 to 2024, including follow-up data from trials like FLARE and EXTRACT-PE, confirm enhanced safety profiles with lower bleeding rates (1.7% major) compared to historical benchmarks.^[33] Management of complications emphasizes intra-procedural interventions, such as deployment of covered stents to seal vessel perforations and restore patency, often combined with prolonged balloon inflation for hemostasis.^[54] Postoperatively, patients with pulmonary embolectomy typically require intensive care unit monitoring for hemodynamic stability and right ventricular function, alongside therapeutic heparin infusion to prevent rethrombosis, initiated within hours of procedure completion once bleeding risk is assessed.^[55] Prophylactic antibiotics are administered perioperatively in surgical cases to mitigate infection risk, with close surveillance for renal function and arrhythmias guiding further supportive care.^[56]

Historical Development

Early Innovations

The concept of embolectomy originated in the late 19th century with Russian surgeon Ivan Sabaneev, who in 1895 proposed the first surgical approach for removing arterial emboli to treat acute limb ischemia, advocating for direct arteriotomy and clot extraction using simple instruments like forceps.^[57] This idea marked a shift from conservative management, which often resulted in amputation or death, though it remained theoretical for decades due to technical limitations. Sabaneev's work laid the groundwork for operative intervention but was not attempted clinically until the early 20th century, as surgeons grappled with the risks of vascular surgery without anticoagulants or modern anesthesia.^[58] Key milestones in peripheral embolectomy followed in the 1910s, with French surgeon Georges Labey performing the first successful removal of a femoral artery embolus in 1911 on a patient with acute ischemia of less than six hours' duration, restoring limb perfusion and avoiding amputation.^[59] This case, reported in collaboration with Mosny, demonstrated the feasibility of arteriotomy and manual clot extraction, inspiring further attempts. In the 1920s, refinements by Labey and other early surgeons like Einar Key improved techniques, including better vessel manipulation and postoperative care, leading to a small series of successful peripheral procedures that reduced immediate operative failures.^[60] These early efforts focused on timely intervention within hours of onset, using basic tools without vascular clamps or bypass, and achieved limb salvage in select cases despite overall poor outcomes. Pulmonary embolectomy emerged as a parallel innovation, driven by German surgeon Friedrich Trendelenburg's 1908 experiments on dogs, where he developed a thoracotomy approach to access the pulmonary artery, temporarily occlude circulation, and extract emboli using forceps.^[61] Trendelenburg applied this to humans shortly after, but initial attempts failed due to intraoperative cardiac arrest. The first successful human pulmonary embolectomy occurred in 1924, performed by Martin Kirschner—Trendelenburg's student—on a patient with massive embolism following hernia surgery, involving pulmonary arteriotomy and clot removal with temporary inflow occlusion, resulting in survival and recovery.^[61] These procedures targeted saddle emboli causing hemodynamic collapse, but required rapid execution to mitigate shock. Early embolectomies faced severe challenges, with mortality rates ranging from 50% to 90% in the 1910s–1930s, primarily from inadequate anesthesia leading to intraoperative instability, postoperative infections due to unsterile conditions, and lack of systemic anticoagulation to prevent re-embolization.^[60] Initial tools were rudimentary—forceps or loops inserted via arteriotomy without bypass support—often causing vessel damage or incomplete clot removal, while patients' underlying cardiac conditions exacerbated risks. These limitations confined the procedure to desperate cases until mid-20th-century advances in perfusion and antibiotics paved the way for broader adoption.

Modern Evolution and Guidelines

The introduction of the Fogarty balloon catheter in 1961 marked a pivotal advancement in embolectomy, enabling minimally invasive removal of arterial emboli through balloon inflation and extraction, which significantly reduced the need for open surgery and improved limb salvage rates to approximately 87% in early applications.^[62] This innovation, developed by Thomas J. Fogarty, laid the foundation for percutaneous techniques and remains a standard tool in vascular interventions.^[63] In the 1990s, percutaneous aspiration thrombectomy gained prominence with devices like the AngioJet rheolytic system, which uses high-velocity saline jets to fragment and aspirate thrombi, offering effective clot removal in peripheral vessels with reduced procedural time compared to earlier methods.^[64] By the 2010s, mechanical thrombectomy for pulmonary embolism (PE) advanced further with systems such as the FlowTriever, approved in 2018 for rapid thrombus retrieval via large-bore aspiration, and the Indigo system from Penumbra, which employs continuous aspiration for fresh emboli, both demonstrating improved right ventricular function in acute PE cases.^[65]^[66] Guideline evolution reflects these technological shifts; the American Heart Association (AHA) in the early 2000s emphasized surgical embolectomy for high-risk PE patients with contraindications to thrombolysis, positioning it as a viable rescue therapy with mortality rates around 20-30% in selected cohorts. The 2019 European Society of Cardiology (ESC) guidelines, updated in subsequent reviews through 2021, incorporated catheter-directed therapies for intermediate-risk PE, recommending devices like aspiration thrombectomy in patients deteriorating on anticoagulation to prevent hemodynamic collapse, with a Class IIa indication for submassive cases.^[17] The 2025 European Society for Vascular Medicine (ESVM) guidelines further emphasize catheter-based therapies for acute venous thromboembolism, recommending involvement of vascular experts for interventional management in high-risk PE.^[67] Recent 2024-2025 investigations, including observational studies on venoarterial extracorporeal membrane oxygenation (VA-ECMO)-assisted procedures, highlight its role as a bridge to thrombectomy in massive PE, showing reduced in-hospital mortality through hemodynamic stabilization during clot removal.^[68]^[69] Contemporary trends emphasize hybrid approaches combining surgical and catheter techniques for complex emboli, alongside AI-assisted imaging for precise clot localization and procedural planning, enhancing detection accuracy in CT pulmonary angiography.^[70] In specialized centers, these evolutions have lowered mortality from about 30-40% in the 1980s to approximately 20% in contemporary series as of 2025, attributed to refined patient selection and device efficacy.^[44]^[71] Global adoption has expanded, particularly in developing regions, facilitated by portable thrombectomy devices that enable interventions in resource-limited settings, contributing to a projected market growth reflecting broader accessibility.^[72]

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A meta-analysis of outcomes of catheter-directed thrombolysis for high
In high-risk PE, clinical success for CDT and usCDT was 70.8% (95% CI, 53.4%-85.8%) and 83.1% (95% CI, 68.5%-94.5%), respectively. In intermediate-risk PE, ...Review Article · Included Studies · Outcomes Based On Pe Type<|separator|>
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National Outcomes of Surgical Embolectomy for Acute Pulmonary ...
In this contemporary, real-world study, mortality occurred in 19.8% of patients undergoing surgical embolectomy for acute pulmonary embolism. This represents a ...Missing: success | Show results with:success<|separator|>
[43]
https://www.sciencedirect.com/science/article/pii/S2213333X18301410
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Surgical Embolectomy of Acute Pulmonary Embolism
Jun 30, 2022 · Recently, mortality occurred in 19.8% of patients undergoing surgical embolectomy for acute PE in another contemporary, nationwide study ( 5 ).Missing: 2020-2023 | Show results with:2020-2023
[45]
Influence of thrombus age on the mechanical thrombectomy efficacy ...
Results: The age of the thrombus had no influence on the activation time necessary for complete thrombolysis. A significant difference was found in the overall ...Missing: embolectomy | Show results with:embolectomy
[46]
Surgical pulmonary embolectomy: state of the art - PMC
Surgical pulmonary embolectomy is a guideline-recommended procedure in selected patients, including salvage therapy for thrombolysis failure.
[47]
Complications of Embolization Procedures and Their Management
Incidence: 1-10% (most common access complication). Mechanism: Bleeding from puncture site into surrounding soft tissues. Risk Factors: Large sheath size, ...
[48]
Percutaneous Management of High-Risk Pulmonary Embolism
Feb 6, 2023 · However, there is often hesitancy to give systemic thrombolysis even in high-risk PE patients, because relative and absolute contraindications ...
[49]
Distal Embolization During Percutaneous Lower Limb Interventions
The incidence of distal embolization during percutaneous interventions in the lower limbs is reportedly low (occurring in approximately 1% to 5% of procedures).
[50]
Distal embolization during lower extremity endovascular interventions
The incidence of DE was 17.3 per 1000 procedures, and 68% required treatment (57% endovascular, 11% open surgery). DE was more common in patients treated for ...Clinical Research Study · Abstract · Procedural CharacteristicsMissing: perforation | Show results with:perforation
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The Outcomes of Surgical Pulmonary Embolectomy for Pulmonary ...
Jul 12, 2024 · Cumulative meta-analysis showed a decline in hospital mortality for SPE from 42.86% in 1965 to 20.56% in 2024. Meta-regression revealed that the ...
[52]
Incidence and outcomes of surgical pulmonary embolectomy in the UK
Jan 17, 2024 · The in-hospital mortality rate was 25%, postoperative stroke occurred in 5.4%, postoperative dialysis was required in 16%, and the reoperation ...
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Perforation Management - Cardiac Interventions Today
Feb 4, 2024 · Deployment of a covered stent at the site of perforation can provide definitive treatment of large-vessel perforations, especially in vessels ...
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Care of the Post-Thrombectomy Patient | Stroke
Oct 9, 2018 · Close, frequent neurological monitoring, especially in the first 24 to 48 hours, is essential for early identification and treatment. Immediate ...Missing: antibiotics | Show results with:antibiotics
[55]
Audit of Anticoagulation After Embolectomy for Acute Ischaemia - PMC
Intravenous unfractionated heparin (UFH) is routinely used in patients after arterial embolectomy. Achieving and maintaining therapeutic levels requires a co- ...
[56]
Ivan F. Sabaneev (1856-1937). The surgeon who first ... - PubMed
Ivan F. Sabaneev (1856-1937). The surgeon who first described thromboembolectomy. Eur J Vasc Endovasc Surg. 1997 Mar;13(3):261-2. doi: ...
[57]
Ivan Sabaneev – The Man behind the Concept of Clot Removal
Most historical treatise report Ivan Sabaneev as the surgeon who first suggested thromboembolectomy for acute arterial occlusion.
[58]
EMBOLECTOMY OF THE PERIPHERAL ARTERIES - JAMA Network
Following his example, many surgeons attempted the operation of embolectomy without avail until Labey2 in 1911 and Key3 in 1912 successfully removed emboli from ...
[59]
Friedrich Trendelenburg and the surgical approach to ... - PubMed
A surgical approach to embolectomy from the pulmonary artery had been worked out in laboratory animals prior to 1908 by Friedrich Trendelenburg.
[60]
Arterial embolectomy before and after the Fogarty catheter - PubMed
The limb salvage rate of 87 percent after Fogarty catheter embolectomy was not statistically different from the salvage rate of 79 percent after suction ...
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NIHF Inductee Thomas Fogarty and the Embolectomy Catheter
Oct 28, 2025 · Fogarty's catheter revolutionized vascular surgery it is still the most widely used technique for blood clot removal and encouraged advances for ...
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Aspiration catheter for percutaneous thrombectomy: clinical results.
Apr 1, 1990 · A new thrombectomy catheter device (AngioJet) for the disruption of thrombi: An in vitro study. PeterStähr, Hans‐JürgenRupprecht ...
[63]
FlowTriever® system for the treatment of pulmonary embolism (PE)
The FlowTriever system is designed for rapid thrombus removal and immediate symptom improvement for patients suffering from acute pulmonary embolism.Missing: modern post WWII Fogarty AngioJet Indigo
[64]
Venous and Arterial Thrombus Removal With the Indigo System
This new thromboaspiration technology allows for clot removal and potential reduction in right heart and PA pressure.
[65]
Role of catheter-based interventions in treating pulmonary embolism
Oct 26, 2025 · The ESC recommends a stratified risk approach-categorizing patients into high, intermediate, and low-risk groups-each associated with ...
[66]
Mechanical Circulatory Support for Massive Pulmonary Embolism
Dec 24, 2024 · This review summarizes the available clinical data on the use of mechanical circulatory support, especially venoarterial extracorporeal membrane oxygenation,
[67]
VA-ECOM assisted percutaneous mechanical thrombectomy ...
Dec 23, 2024 · VA-ECMO-assisted PMT technology can rapidly improve pulmonary hemodynamics while maintaining stable blood flow, thereby reducing in-hospital mortality.
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AI-Enhanced Deep Learning Framework for Pulmonary Embolism ...
Comparative analysis of recent deep learning approaches for pulmonary embolism (PE) detection and segmentation using CT pulmonary angiography (CTPA).
[69]
Twenty-year results of surgical pulmonary thromboembolectomy in ...
Five percent of acute pulmonary embolism cases fall in the category of massive PE with a three-month mortality rate of 58% in patients that presented with ...
[70]
Surgical Pulmonary Embolectomy | Circulation
Sep 22, 2015 · ... embolectomy could be a valid option for patients with submassive PE at high risk for adverse outcomes or with contraindications to fibrinolysis.Case Presentation · Introduction · Case Follow-Up<|control11|><|separator|>
[71]
Global Thrombectomy Devices Market to Witness Growth at a CAGR of
Jun 4, 2024 · These devices are engineered to swiftly and effectively remove blood clots from arteries, restoring blood flow to the affected area and ...Missing: portable | Show results with:portable