Arterial embolectomy in lower limbs

Arterial embolisms in the lower limbs occur frequently, and are of great interest to the vascular surgeon. The authors studied 159 cases of arterial embolisms in lower limbs from January 1991 to July 1993. Ages varied from 12 to 98, with a mean of 58. Eighty patients were male and 78 were female. In most cases, etiology of the embolus was well-established, and mainly caused (78 percent) by atrial fibrillation. Oclusion was most frequent in the femoral artery (53.4 percent). All patients presented severe lower limb ischemia, but not gangrene, on admission. The duration of ischemia, between of onset of symptoms and the liberation of arterial flow, was in most patients (67.9 percent) less than 24 hours. All patients were submitted to lower limb embolectomy with the Fogartyy catheter, of which 70.9 percent were done through the femoral artery. Fasciotomy was performed on 48 patients due to a compartimental syndrome. Nineteen patients died immediately after operation; 68.4 percent due to heart failure. Twenty-three (16.4 percent) of the 140 surviving patients (150 operated limbs) were submitted to amputations after the occlusion of artery branches, which had undergone embolectomies. One hundred and twenty-seven limbs (84.6 percent) were preserved in 117 patients (83.5 percent). Eleven cases (7.3 percent) required repeated surgery with the Fogarty catheter. The patients wich muscle tenderness, paralysis, or ischemia lasting longer than 24 hours had worse results in relation to the preservation of the limb (p<0.05). We conclude that patients who present lower limb embolisms, are in good clnical condition, and who do not have any necrosis in the limbs, have good outcomes as to limb preservation, along with low complication rates, after embolectomy with the Fogarty catheter. Limb preservation was significantly higher in patients who did not present muscle tenderness, and who had normal motor activity and a ischemia duration of less than 24 hours.

Trauma to arteries of the forearm

O trauma de artérias do antebraço corresponde a 20 por cento do total de traumas arteriais. Os autores analisaram 24 pacientes com trauma näo iatrogênico de artérias do antebraço, atendidos de janeiro de 1987 a dezembro de 1990. Todos os pacientes eram do sexo masculino, o trauma por agente penetrante foi o mais freqüente, com 21 casos (87,5 por cento), a ausência de pulsos foi a manifestaçäo clínica mais freqüente (62,5 por cento), quinze pacientes näo apresentavam manifestaçöes isquêmicas (54,2 por cento) e metade dos doentes eram assintomáticos do ponto de vista neurológico. Constatou-se lesäo isolada de uma artéria em 11 casos, sendo cinco de artéria radial (20,8 por cento), cinco de artéria ulnar (20,8 por cento) e uma de artéria interóssea (4,2 por cento). Lesäo concomitante das artérias radial e ulnar foi verificada em 13 casos (54,1 por cento). Quanto ao comprometimento nervoso, constatou-se lesäo de nervo radial em 4 casos (16,6 por cento) e de nervos mediano e ulnar em um caso cada (4,1 por cento). Todos os pacientes com lesäo conjunta das artérias radial e ulnar (13) foram submetidos e restauraçäo arterial. Os 11 pacientes com lesäo isolada de uma artéria de antebraço foram tratados da seguinte maneira: ligadura de artéria interóssea em um caso, ligadura de artéria radial em quatro casos, rafia de artéria radial em um caso, ligadura de artéria ulnar em trés casos, restauraçäo de artéria ulnar com segmento de safena em dois casos nos quais o teste de Allen foi positivo. Um paciente faleceu no pós-operatório imediato devido a falência de múltiplos órgäos por politraumatismo. A preservaçäo do membro foi obtida em 23 doentes (95,8 por cento) e a única amputaçäo, se deveu a traumatismo de partes moles extenso com infecçäo grave e comprometimento sistêmico