title: Microtibial embolectomy.
abstract: BACKGROUND
  microtibial embolectomy is an important technique in cases of limb threatening acute arterial occlusion affecting native crural and pedal vessels. It is particularly useful when thrombolysis is contraindicated or ineffective as in "trash foot".
  
  
  METHODS
  in order to evaluate the efficacy of this technique, a retrospective case note review was carried out for patients undergoing microtibial embolectomy from 1990 to 1999. Data collected included the causes and degree of ischaemia, additional procedures required, vessel patency, limb salvage and complications encountered.
  
  
  RESULTS
  twenty-two limbs underwent exploration of the crural/pedal vessels with ankle level arteriotomies under local anaesthetic in 12 cases, general anaesthetic in nine and epidural in one. The causes of ischaemia were cardiac emboli (8), "trash foot" (7), emboli from aortic and popliteal aneurysms (3) and thrombotic occlusion of crural vessels (4). The vessel patency rate was 69% and limb salvage rate 62% (13/21) up to 5-years follow-up. Six of the seven cases with "trash foot" were salvaged while one required an amputation at 3-months post-operatively. The 30-day mortality was 22% (5/22).
  
  
  CONCLUSIONS
  microtibial embolectomy is effective in acute occlusion of the crural/pedal arteries including cases of "trash foot", offering limb salvage to a worthwhile proportion of cases.
authors.affiliation: Department of Vascular Surgery, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Raddlebarn Road, Selly Oak, Birmingham B29 6JD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mahmood
authors.forename: R
authors.initials: R
authors.lastname: Hardy
authors.forename: A
authors.initials: A
authors.lastname: Garnham
authors.forename: Y
authors.initials: Y
authors.lastname: Samman
authors.forename: M
authors.initials: M
authors.lastname: Sintler
authors.forename: S R g
authors.initials: SR
authors.lastname: Smith
authors.forename: R K
authors.initials: RK
authors.lastname: Vohra
authors.forename: M H
authors.initials: MH
authors.lastname: Simms
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017128:Embolectomy / Q000379:methods*; D005260:Female; D005528:Foot / Q000098:blood supply; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013923:Thromboembolism / Q000601:surgery*; D016909:Tibial Arteries / Q000601:surgery*; D016896:Treatment Outcome