Embolectomy (Fogarty Catheter)
What the Examiner Expects
Surgical removal of an arterial embolus using a balloon-tipped (Fogarty) catheter, the standard emergency procedure for acute limb ischemia from embolism. The examiner expects you to recognize the 6 P's of acute limb ischemia, classify the severity (Rutherford I — viable, II — threatened, III — irreversible), and know that Rutherford IIb (immediately threatened) requires emergent revascularization. The technique involves exposing the common femoral artery, performing a transverse arteriotomy, passing the deflated Fogarty catheter distally and proximally beyond the clot, inflating the balloon, and withdrawing it to extract the thrombus. Multiple passes are made until no further clot is retrieved and good inflow/backflow is established.
Key Examiner Focus Points
- Indicated for acute limb ischemia from arterial embolus (atrial fibrillation is #1 cause)
- Fogarty balloon catheter: insert beyond the clot, inflate, withdraw to extract thrombus
- Perform through arteriotomy (typically at common femoral artery — groin access)
- Completion angiography to confirm complete clot removal
- 4-compartment fasciotomy if ischemia time > 4–6 hours (reperfusion injury risk)
Common Curveballs
The limb has been ischemic for 8 hours — after revascularization, the calf is swollen and tense
Reperfusion injury with compartment syndrome. Perform four-compartment fasciotomy immediately. Monitor for systemic reperfusion effects: hyperkalemia (from muscle breakdown), metabolic acidosis, myoglobinuria (risk of AKI). Aggressive IV hydration and sodium bicarbonate for urine alkalinization.
The Fogarty catheter cannot pass distally beyond the popliteal artery
The embolus may have fragmented into the tibial vessels. Options: intraoperative thrombolysis (catheter-directed TPA), use of smaller (3 or 4 Fr) Fogarty catheters in the tibial vessels, or intraoperative angiography with selective catheterization. If flow cannot be restored and the limb is not viable, amputation may be necessary.
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