Embolectomy is indicated for:

• Acute limb ischemia (ALI):
  
  • Sudden blockage of a peripheral artery (e.g., femoral, popliteal) causing severe pain, pallor, pulselessness, paresthesia, and paralysis (“5 Ps”).
  • Common source: Embolus from atrial fibrillation (AF, 70–80% of cases; 10–15% of AF patients develop emboli) or mural thrombus post-heart attack (as in your angioplasty query).
  • Prevalence in India: 1–3 per 10,000 annually; higher in elderly, diabetics, and smokers.
• Pulmonary embolism (PE):
  
  • Massive PE causing hemodynamic instability (e.g., low BP, shock); rare indication for surgical embolectomy (5% of PE cases).
  • Incidence in India: 5–10% of hospitalized patients with risk factors (e.g., surgery, immobility).
• Other indications:
  
  • Mesenteric artery embolism (bowel ischemia; rare, <1%).
  • Stroke (large vessel occlusion; typically managed with thrombectomy, a related procedure).
• Types:
  
  • Surgical embolectomy: Open surgery to remove clot (e.g., femoral artery).
  • Catheter-directed embolectomy: Minimally invasive; uses suction or balloon catheter (e.g., Fogarty catheter).
• Associated treatments:
  
  • Pre-op: Heparin (anticoagulation) to prevent clot propagation.
  • Post-op: Anticoagulation (e.g., warfarin, DOACs like rivaroxaban) for 3–6 months or lifelong if AF.
• Timing:
  
  • Performed in adults (average age 60–80 years for ALI); emergency within 6–12 hours of symptom onset for limb salvage (90% success if <6 hours, 50% if >12 hours).

The procedure aims to restore blood flow, prevent amputation or organ damage, and address the underlying cause (e.g., AF), with a high success rate if performed timely.

• Before Procedure Evaluation:
  
  • Assessment:
    
    • Clinical exam: “5 Ps” for ALI; Doppler ultrasound confirms absent pulses.
    • Imaging: CT angiography (CTA) or MR angiography to locate embolus (e.g., femoral artery occlusion).
    • Blood tests: Clotting profile (INR, aPTT), kidney function (contrast dye risk), D-dimer (if PE suspected).
    • ECG/Echocardiogram: Identifies AF or cardiac thrombus (common sources).
  • Preparation: Heparin bolus, no fasting (emergency); consent obtained quickly.
  • Consent: Risks, including amputation, are explained.
• Procedure Technique:
  
  • Surgical Embolectomy (Femoral Artery):
    
    • Performed under local or general anesthesia, lasting 1–2 hours.
    • Process:
      
      • Incision: 5–7 cm over artery (e.g., groin for femoral artery).
      • Artery exposed; clamps placed above and below embolus.
      • Arteriotomy: Small incision in artery; Fogarty balloon catheter inserted, inflated beyond clot, and pulled back to extract embolus.
      • Artery flushed with heparinized saline; repeat passes to ensure clearance.
      • Closure: Artery sutured (sometimes with patch); skin closed with sutures; drain (if needed).
  • Catheter-Directed Embolectomy:
    
    • Performed under local anesthesia with sedation, lasting 1–2 hours.
    • Process:
      
      • Access: Catheter inserted via femoral artery (opposite side).
      • Angiogram: Confirms embolus location; suction catheter (e.g., AngioJet) or Fogarty catheter removes clot.
      • Post-procedure angiogram: Ensures vessel patency.
  • Intraoperative Tools:
    
    • Fogarty catheter: Balloon extracts clot (standard for surgical).
    • Suction catheter: Removes clot (catheter-directed).
    • Doppler: Confirms restored flow intra-op.
• After Procedure:
  
  • Hospital stay: 3–5 days (ALI); 5–7 days (PE, if surgical).
  • Care: Monitor pulses, limb perfusion; anticoagulation started (e.g., heparin IV, then warfarin).
  • Pain management: Moderate pain for 1–3 days (incision site); managed with painkillers (e.g., tramadol).
  • Instructions: Avoid heavy lifting for 2–4 weeks; monitor for bleeding or limb changes.