Embolectomy and treatment of acute arterial thrombosis

Acute limb ischaemia is the sudden interruption of blood flow in an artery, usually in the leg, sometimes in the arm. It is caused either by a clot travelling from elsewhere (embolism, often from the heart when the rhythm is irregular), or by thrombosis of an already diseased artery or a bypass. The limb becomes cold, pale and painful, then loses sensation and strength: this is an emergency. Embolectomy involves reaching the artery through a small incision, usually in the groin or at the elbow crease, then removing the clot with a catheter fitted with a small balloon (Fogarty catheter). Depending on the cause, the surgeon may complete the procedure with balloon angioplasty, a stent, a bypass, or thrombolysis (medication that dissolves the clot). If the muscles have swollen, opening their sheath (fasciotomy) relieves the pressure. The faster the procedure, the better the chances of saving the limb without after-effects: ideally within the first few hours. Anticoagulation is started as soon as the diagnosis is made. After surgery, the cause is investigated (heart, arteries) to prevent recurrence. At Clinique Pasteur Tunis, these patients are managed from the emergency department, with access to the operating theatre, to the catheterisation laboratory for imaging and endovascular procedures, and to intensive care when needed.