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Clinical and Histopathological Correlation in Cases Undergoing Embolectomy for Acute Extremity Ischemia

Year 2025, Issue: 27, 860 - 871, 31.12.2025
https://doi.org/10.38079/igusabder.1578054

Abstract

Aim: Acute extremity ischemia (AEI) is a disease in which the arterial perfusion of the limb is suddenly reduced, mostly due to a thromboembolic condition. There is a need for an urgent evaluation and intervention, most commonly surgical embolectomy. Surgically removed thrombus materials can provide information about the disease and its process.
Method: Patients who underwent embolectomy for acute extremity ischemia between November 2021 and March 2022 were retrospectively analyzed, and the obtained embolectomy materials were histopathologically evaluated.
Results: We included 32 cases of patients who underwent embolectomy surgery for AEI. The histopathological evaluation of the materials taken from these cases determined that the thrombus age was compatible with the first 48 hours. Malignant epithelial tumor cells were detected in one case. In addition, we assessed and showed that re-intervention was significantly higher in cases with a high fibrin score with chronic peripheral artery disease.
Conclusion: We believe that the histopathological evaluation of the materials removed from patients who underwent embolectomy surgery for acute extremity ischemia can aid in diagnosis, guide treatment, and provide valuable prognostic information.

References

  • 1. Björck M, Earnshaw JJ, Acosta S, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ıschaemia. Eur J Vasc Endovasc Surg. 2020;59(2):173-218.
  • 2. Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: When and how to intervene. Semin Vasc Surg. 2009;22(1):5-9.
  • 3. Purushottam B, Gujja K, Zalewski A, Krishnan P. Acute limb ischemia. Interv Cardiol Clin. 2014;3(4):557-572. doi: 10.1016/j.iccl.2014.07.004.
  • 4. Beckman JA, Schneider PA, Conte MS. Advances in revascularization for peripheral artery disease: Revascularization in PAD. Circ Res. 2021;128(12):1885-1912.
  • 5. de Donato G, Pasqui E, Setacci F, et al. Acute on chronic limb ischemia: From surgical embolectomy and thrombolysis to endovascular options. Semin Vasc Surg. 2018;31(2-4):66-75. doi: 10.1053/j.semvascsurg.2018.12.008.
  • 6. Fogarty TJ, Cranley JJ. Catheter technıc for arterıal embolectomy. Ann Surg. 1965;161(3):325-30. doi: 10.1097/00000658-196503000-00001.
  • 7. Mitchell RN. Hemodynamic disorders, thromboembolic disease, and shock. In: Kumar V, Abbas AK, Fausto N (eds). Pathologic Basis of Disease. 7th ed. Philadelphia: Elsevier; 2005.
  • 8. Knighton DR, Fiegel VD. The macrophages: Effector cell wound repair. Prog Clin Biol Res. 1989;299:217–226.
  • 9. Henke PK, Pearce CG, Moaveni DM, et al. Targeted deletion of CCR2 impairs deep vein thombosis resolution in a mouse model. J Immunol. 2006;177:3388–3397.
  • 10. Henke PK, Varga A, De S, et al. Deep vein thrombosis resolution is modulated by monocyte CXCR2-mediated activity in a mouse model. Arterioscler Thromb Vasc Biol. 2004;24:1130–1137.
  • 11. Varma MR, Varga AJ, Knipp BS, et al. Neutropenia impairs venous thrombosis resolution in the rat. J Vasc Surg. 2003;38:1090– 1098.
  • 12. Nosaka M, Ishida Y, Kimura A, Kondo T. Time-dependent appearance of intrathrombus neutrophils and macrophages in a stasis-induced deep vein thrombosis model and its application to thrombus age determination. Int J Legal Med, 2004;123:235–240.
  • 13. Moller P. Studien uber die embolische und autochtone thrombose in der A. Beitr. Path. Anat, Pulmonalis, 1925.
  • 14. Sevitt S. Organic fragmentation in pulmonary thrombo-emboli. J Pathol. 1977;122:95–103.
  • 15. Olsen EGJ. The Pathology of The Heart. London: Unıversity Park Press; 1980.
  • 16. Leu AJ, Leu HJ. Special problems in the histologic age determination of thrombi and emboli. Der Pathologe. 1989;10(2):87–92.
  • 17. Schäfer V. Altersbestimmungen von Thrombosen und Embolien unter besonderer Berücksichtigung forensischer Gesichtspunkte. Universität Hamburg; 1977.
  • 18. Fineschi V, Turillazzi E, Neri M, Pomara RI. Histological age determination of venous thrombosis: A neglected forensic task in fatal pulmonary thrombo-embolism. Forensic Sci Int. 2009;186:22–28.
  • 19. Maffeis V, Nicolè L, Rago C, Fassina A. Histological criteria for age determination of fatal venous thromboembolism. Int J Legal Med. 2018;132(3):775-780.
  • 20. Carol A, Bernet M, Curós A, et al. Thrombus age, clinical presentation, and reperfusion grade in myocardial infarction. Cardiovasc Pathol. 2014;23(3):126–130.
  • 21. Mansueto G, Costa D, Capasso E, et al. The dating of thrombus organization in cases of pulmonary embolism: An autopsy study. BMC Cardiovasc Disord. 2019;19(1):250.

Akut Ekstremite İskemisi Nedeniyle Embolektomi Yapılan Olgularda Klinik ve Histopatolojik Korelasyon

Year 2025, Issue: 27, 860 - 871, 31.12.2025
https://doi.org/10.38079/igusabder.1578054

Abstract

Amaç: Akut ekstremite iskemisi (AEI), çoğunlukla tromboembolik bir duruma bağlı olarak, ekstremite arteriyel perfüzyonunun aniden azaldığı bir hastalıktır. Çoğunlukla cerrahi embolektomi olmak üzere acil bir değerlendirme ve müdahaleye ihtiyaç vardır. Ameliyatla çıkarılan trombüs materyalleri hastalık ve süreci hakkında bilgi verebilir.
Yöntem: Kasım 2021-Mart 2022 tarihleri arasında akut ekstremite iskemisi nedeniyle embolektomi yapılan olgular retrospektif olarak incelendi ve elde edilen embolektomi materyalleri histopatolojik olarak incelendi.
Bulgular: AEI nedeniyle embolektomi ameliyatı yapılan 32 olgu çalışmaya dahil edildi. Bu olgulardan alınan materyallerin histopatolojik değerlendirmesi sonucunda trombüs yaşının ilk 48 saat ile uyumlu olduğu belirlendi. Bir olguda alınan materyalde malign epitelyal tümör hücreleri saptandı. Ayrıca değerlendirmede kronik periferik arter hastalığı olan yüksek fibrin skorlu olgularda tekrar girişimin anlamlı olarak daha yüksek olduğu görüldü.
Sonuç: Akut ekstremite iskemisi nedeniyle embolektomi ameliyatı geçiren hastalarda çıkarılan materyallerin histopatolojik olarak değerlendirilmesinin tanı ve tedaviye katkı sağlamanın yanı sıra prognostik bilgi sağlayacağı düşünülmektedir.

References

  • 1. Björck M, Earnshaw JJ, Acosta S, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ıschaemia. Eur J Vasc Endovasc Surg. 2020;59(2):173-218.
  • 2. Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: When and how to intervene. Semin Vasc Surg. 2009;22(1):5-9.
  • 3. Purushottam B, Gujja K, Zalewski A, Krishnan P. Acute limb ischemia. Interv Cardiol Clin. 2014;3(4):557-572. doi: 10.1016/j.iccl.2014.07.004.
  • 4. Beckman JA, Schneider PA, Conte MS. Advances in revascularization for peripheral artery disease: Revascularization in PAD. Circ Res. 2021;128(12):1885-1912.
  • 5. de Donato G, Pasqui E, Setacci F, et al. Acute on chronic limb ischemia: From surgical embolectomy and thrombolysis to endovascular options. Semin Vasc Surg. 2018;31(2-4):66-75. doi: 10.1053/j.semvascsurg.2018.12.008.
  • 6. Fogarty TJ, Cranley JJ. Catheter technıc for arterıal embolectomy. Ann Surg. 1965;161(3):325-30. doi: 10.1097/00000658-196503000-00001.
  • 7. Mitchell RN. Hemodynamic disorders, thromboembolic disease, and shock. In: Kumar V, Abbas AK, Fausto N (eds). Pathologic Basis of Disease. 7th ed. Philadelphia: Elsevier; 2005.
  • 8. Knighton DR, Fiegel VD. The macrophages: Effector cell wound repair. Prog Clin Biol Res. 1989;299:217–226.
  • 9. Henke PK, Pearce CG, Moaveni DM, et al. Targeted deletion of CCR2 impairs deep vein thombosis resolution in a mouse model. J Immunol. 2006;177:3388–3397.
  • 10. Henke PK, Varga A, De S, et al. Deep vein thrombosis resolution is modulated by monocyte CXCR2-mediated activity in a mouse model. Arterioscler Thromb Vasc Biol. 2004;24:1130–1137.
  • 11. Varma MR, Varga AJ, Knipp BS, et al. Neutropenia impairs venous thrombosis resolution in the rat. J Vasc Surg. 2003;38:1090– 1098.
  • 12. Nosaka M, Ishida Y, Kimura A, Kondo T. Time-dependent appearance of intrathrombus neutrophils and macrophages in a stasis-induced deep vein thrombosis model and its application to thrombus age determination. Int J Legal Med, 2004;123:235–240.
  • 13. Moller P. Studien uber die embolische und autochtone thrombose in der A. Beitr. Path. Anat, Pulmonalis, 1925.
  • 14. Sevitt S. Organic fragmentation in pulmonary thrombo-emboli. J Pathol. 1977;122:95–103.
  • 15. Olsen EGJ. The Pathology of The Heart. London: Unıversity Park Press; 1980.
  • 16. Leu AJ, Leu HJ. Special problems in the histologic age determination of thrombi and emboli. Der Pathologe. 1989;10(2):87–92.
  • 17. Schäfer V. Altersbestimmungen von Thrombosen und Embolien unter besonderer Berücksichtigung forensischer Gesichtspunkte. Universität Hamburg; 1977.
  • 18. Fineschi V, Turillazzi E, Neri M, Pomara RI. Histological age determination of venous thrombosis: A neglected forensic task in fatal pulmonary thrombo-embolism. Forensic Sci Int. 2009;186:22–28.
  • 19. Maffeis V, Nicolè L, Rago C, Fassina A. Histological criteria for age determination of fatal venous thromboembolism. Int J Legal Med. 2018;132(3):775-780.
  • 20. Carol A, Bernet M, Curós A, et al. Thrombus age, clinical presentation, and reperfusion grade in myocardial infarction. Cardiovasc Pathol. 2014;23(3):126–130.
  • 21. Mansueto G, Costa D, Capasso E, et al. The dating of thrombus organization in cases of pulmonary embolism: An autopsy study. BMC Cardiovasc Disord. 2019;19(1):250.
There are 21 citations in total.

Details

Primary Language English
Subjects Surgery (Other), Pathology
Journal Section Research Article
Authors

Abdul Kerim Buğra 0000-0001-9575-0100

Aytül Buğra 0000-0001-5640-8329

Burak Ersoy 0000-0003-4463-9730

Salih Güler 0000-0003-2077-8488

Zinar Apaydın 0000-0002-3041-1172

Submission Date November 5, 2024
Acceptance Date November 12, 2025
Publication Date December 31, 2025
Published in Issue Year 2025 Issue: 27

Cite

JAMA Buğra AK, Buğra A, Ersoy B, Güler S, Apaydın Z. Clinical and Histopathological Correlation in Cases Undergoing Embolectomy for Acute Extremity Ischemia. IGUSABDER. 2025;:860–871.

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