Amputation is one of the oldest surgical procedures known to humans. The earliest forms of below-knee amputation (BKA) occurred on or near battlefields, where wounded warriors had few alternatives other than to face the surgeon’s knife. Amputations for lower extremity…
The first use of limb amputation was as an implement of punishment or torture. Hippocrates is credited with performing the first amputation for therapeutic purposes. Well into the 20th century, toe or forefoot gangrene was associated with limb loss. Leland…
Peripheral arterial macroembolism is an important cause of acute limb ischemia. Identification of the underlying source is imperative in managing the threatened extremity and preventing recurrence. Many noninvasive studies are readily available that can aid in identifying the cardiac and…
Acute lower extremity ischemia remains a common vascular disease with considerable associated morbidity, limb loss, and mortality. Both arterial embolism and thrombosis are recognized causes of acute limb ischemia. It is imperative that a distinction between the two be made…
Acute limb ischemia and thromboembolic events continue to remain a challenge to vascular surgeons. Pharmacologic thrombolysis and, more recently, percutaneous mechanical thrombectomy have proved to hold great potential in this regard. Both techniques can effectively clear peripheral arteries from occluding…
Distal embolization of atherosclerotic debris to the foot is a serious and challenging dilemma. Most commonly it occurs during open and endovascular aortoiliac aneurysm repair, but it is also known to occur during lower extremity endovascular interventions as well as…
Atheroembolism is the process of embolization of atherosclerotic plaque debris into small arteries and arterioles. Atheroembolism, mainly caused by cholesterol crystals, can occur spontaneously, but more commonly it follows interventional procedures and anticoagulation. Spontaneous atheroembolism as a result of extensive…
Paradoxical embolism describes an event in which embolic material originates in the venous system or right heart, passes through any right-to-left shunt, and ends in the arterial system. Although this sequence of events usually is thought to occur with venous…
Arterial macroembolism causes significant morbidity and is associated with mortality. In the limb, an arterial macroembolism causes one of the most common vascular emergencies: acute limb ischemia (ALI). Prompt recognition and diagnosis followed by rapid restoration of blood flow to…
Heparin is routinely used during vascular and endovascular surgery; its use is ubiquitous among hospitalized patients. Vascular surgeons must therefore be familiar with both the major nonbleeding and bleeding complications associated with its use. The most important nonbleeding complications include…