Arterial thromboembolism. A 20-year perspective

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Tawes RL Jr. Harris EJ. Brown WH. Shoor PM. Zimmerman JJ. Archives of Surgery. 120(5):595-9, 1985 May. Our experience with 739 patients with lower extremity thromboembolism since the advent of the balloon catheter has led us to several important observations: As the etiology has shifted from rheumatic to atherosclerotic, we treat a more complex group of patients, one fourth of whom have severe, preexisting peripheral occlusive disease. Early diagnosis and treatment is essential to decrease the mortality and morbidity, which has ranged about 25% +/- 10%. Anticoagulation must be continued in the postoperative period, accepting wound hematomas as a fair "trade-off" to prevent recurrent embolus and distal thrombosis in areas inaccessible to the catheter. Postoperative use of heparin "buys time" to further assess marginal results of embolectomy allowing arteriography and careful planning of secondary operations to assure not only a viable but a functional limb. There is little mention in the literature to emphasize this approach, which we think is essential for long-term salvage. Early in the series, patients were treated with heparin or embolectomy alone. There were 161 secondary operations in 135 patients following embolectomy consisting of repeated thromboembolectomy, popliteal exploration,