Investigation of the embolic foci through echocardiographic evaluation in patients undergoing urgent femoral embolectomy.
OBJECTIVE
The determination of the source of embolism in patients with lower extremity arterial emboli is a major clinical problem. A review of the literature focusing on large patient series showed that the heart is the embolic source in 78% of these patients. The aim of this study was to determine the role of early postoperative echocardiographic investigations in the determination of embolic origin.


METHODS
This retrospective study group consisted of 57 patients in whom we performed 63 unilateral and bilateral urgent femoral embolectomies. Bilateral urgent femoral embolectomy was performed in 6 of the 57 patients included in the study and unilateral intervention was performed in the rest. Besides the features regarding age and sex, the cardiac rhythms of the patients during their application to our clinic were evaluated. In order to determine the origin of the acute peripheral arterial occlusion, transthoracic echocardiography was performed in all patients in the first 24 hours after the embolectomy.


RESULTS
In 6 patients who underwent bilateral femoral embolectomy, distinct heart valve pathologies were determined. As for the 51 patients who underwent urgent unilateral femoral embolectomy, it was determined that 28 (55%) had serious cardiac pathologies. Among these 28 patients, 14 (50%) underwent the required open-heart surgery interventions after the completion of further examinations. It was determined that, in our series, 14 (64%) of the 22 patients with serious mitral valve pathologies had a history of acute joint rheumatism.


CONCLUSIONS
Regardless of whether the interventions are bilateral or unilateral, we believe that echocardiographic investigation should be performed in all patients during the early postoperative period in order to prevent recurrence by the determination of the thromboemboli source. Thus, accompanying serious intracardiac pathologies can be treated and the development of additional peripheral emboli can be prevented.
Yetkin
Ufuk
U
Department of Cardiovascular Surgery, Izmir Atatürk Training and Research Hospital, Izmir, Turkey. ufuk_yetkin@yahoo.fr
Abud
Burçin
B
Gökalp
Orhan
O
Ozpak
Berkan
B
Sahin
Aykut
A
Göktoğan
Tayfun
T
Gürbüz
Ali
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography / Q000379:methods*; D017128:Embolectomy / Q000379:methods*; D004617:Embolism / Q000000981:diagnostic imaging* / Q000601:surgery; D004630:Emergencies; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000601:surgery*; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler