Ultrasound-based quantification of emboli during conventional and endovascular aneurysm repair.
OBJECTIVE
To differentiate and quantify the type and number of lower limb emboli occurring during endovascular aneurysm repair, as compared to conventional surgery.


METHODS
Thirty-eight patients underwent elective infrarenal aneurysm repair using a conventional surgical approach in 18 and an endovascular procedure in 20. Emboli were detected using a Doppler ultrasound system with a 2-MHz transducer interrogating the mid superficial femoral artery. Lower limb emboli were differentiated as particulate or gaseous based on the physical distance traversed by the embolic signal.


RESULTS
Significantly more particulate (median 108 versus 59, p = 0.015) and gaseous (134 versus 46, p = 0.008) emboli were detected during endovascular aneurysm repair as compared to conventional surgery. Clinically, no case of massive microembolization occurred in either group, but one patient in the conventional group required a femoral embolectomy, and three patients undergoing endovascular repair developed self-limiting trash feet postoperatively. In patients undergoing endovascular aortomonoiliac aneurysm repair, there was only a poor correlation between the number of particulate emboli and either procedural duration or operator experience.


CONCLUSIONS
The apparent lack of a relationship between particulate embolization and operative time or technical experience suggests that manipulation of endoluminal devices within the aneurysm sac may not be the sole determinant of intraprocedural embolization. Other as yet undetermined factors may predict patients at high risk for massive embolization.
Thompson
M M
MM
Department of Surgery, University of Leicester, United Kingdom.
Smith
J
J
Naylor
A R
AR
Nasim
A
A
Sayers
R D
RD
Boyle
J R
JR
Tinkler
K
K
Goodall
S
S
Evans
D
D
Bell
P R
PR
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017128:Embolectomy / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012307:Risk Factors; D013923:Thromboembolism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D018608:Ultrasonography, Doppler / Q000379:methods*