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A D V E R T I S E M E N T
A D V E R T I S E M E N T
Introduction
The Fogarty Arterial Embolectomy Catheter introduced to vascular surgery the concept and capability of remote treatment of arterial pathology. Since its introduction in 1963, it has become the standard for removal of peripheral emboli and thrombus. It has generated a variety of imitations. The parallel development of the Seldinger technique and a host of other “over-the wire” based catheter technologies led to the latest guidewire compatible iteration of the Fogarty balloon catheter, the Thru-Lumen Embolectomy Catheter (TLW). This catheter incorporates the same compliant, concentric balloon technology and catheter as the standard Fogarty, but adds an additional lumen which can be used to guide the catheter over a wire or for fluid delivery.
The Fogarty TLW Catheter is manufactured in 3 - 7 French sizes which accommodate a variety of standard guidewire diameters (0.018”, 0.025”, 0.035”, 0.038”). There are two lengths available, 40 cm. and 80 cm. Stainless steel bushings located at the proximal and distal ends of the balloon enable accurate visualization under fluoroscopy.
This short monograph will discuss the expanded capabilities of the Fogarty TLW catheter for its traditional techniques as well as other methods not traditionally utilized with this type of catheter.
A D V E R T I S E M E N T
Image-Guided Embolectomy/Thrombectomy
Embolectomy and thrombectomy procedures were revolutionized by the introduction of the Fogarty catheter. With the introduction of a balloon catheter, it became possible to extract emboli and thrombi from remote locations through proximal or distal open arterial access. Primary endpoints of success or failure of the original techniques were: a) ability to pass the catheter down the arterial segment, b) extraction of thrombus, and c) the restoration or enhancement of backbleeding at the arteriotomy. The technique was “blind” in the sense that one had no ability to visualize the extent and location of thrombus. While results were vastly superior to the historical controls at that time, there were still significant failures, as well as iatrogenic injuries from balloon inflation and the repetitive trauma of the balloon shear on the arterial wall. The regulation of balloon inflation is subjective and proper inflation and deflation during withdrawal is a skill acquired over the course of many years using the technique.
The addition of fluoroscopy to many operating room environments and the guidewire lumen in the Fogarty TLW catheters makes possible a far more controlled, reproducible and accessible technique for thrombectomy and embolectomy. The technique is described below.
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A D V E R T I S E M E N T
Arterial Access: an appropriate site for access is chosen based on suspected location of the thrombus and ease of access and wound healing. Lower extremity embolus can involve the common femoral, profunda femoris, and superficial femoral arteries separately or in any combination thereof.
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This page was last modified on 4/3/2002.
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