Which of the following is the least reliable indicator of successful thrombectomy?

A. Vigorous back-bleeding after removal of thrombotic material.

DISCUSSION: The significant incidence of discontinuous thrombus makes the presence of vigorous back-bleeding an unreliable indicator of distal patency. Proximal material can be cleared, precipitating back-bleeding from all side branches yet still leaving the main vessel occluded more distally. Arteriography, normal distal pulses, and the return of normal skin color and temperature are the best indicators of distal patency, and thus of successful reperfusion. It must be borne in mind that the primary goal of most thromboembolectomy procedures is to return the limb to its preocclusive state. Optimal distal perfusion may require additional therapy for the patient with chronic atherosclerotic disease.