The Management of Peripheral Arterial Emboli.

ONE of the main difficulties in assessing the results of any surgical procedure is the provision of a directly comparable series of patients on whom it has not been employed. Nowhere is this more evident than in trying to determine the value of embolectomy in the management of peripheral arterial emboli. The problem of comparing the results of conservative and operative management is considerable, due to the fact that conservative treatment is employed in poor risk patients in whom surgery of any kind is inadvisable and also in those patients whose ilimbs are recovering spontaneously when they are first seen. Peripheral arterial embolism is a grave condition. This is evidenced by the fact that in most published series of cases the mortality rate is in excess of 40 per cent whether embolectomy has been employed or not. It has even been suggested that in some series where surgical intervention was extensively employed, the mortality rate was higher than if conservative management alone was used. However, we feel this does not necessarily mean that surgery should not be advised. Although the overalil results are poor in terms of mortality and loss of limb attributable to the natural history of the disease, a worthwhile result can be achieved in a minority of patients whose limb would not otherwise be restored to normal function. Tihe problem of selection of those patients who are likely to benefit from embolectomy is difficult if not impossible. It is therefore inevitable that the procedure will be employed in a number of instances where the eventual outcome is fatal.