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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
The Journal of Cardiovascular Surgery 2016 Nov 30
Risk factors analysis of thromboembolectomy for acute thromboembolic lower extremity ischemia in native arteries
Gabriele PIFFARETTI 1, Alessandro ANGRISANO 1, Marco FRANCHIN 1, Massimo FERRARIO 1, Nicola RIVOLTA 1, Alessandro BACUZZI 2, Patrizio CASTELLI 1, Matteo TOZZI 1 ✉
1 Vascular Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Hospital, Varese, Italy; 2 Anesthesia And Palliative Care, Circolo University Hospital, Varese, Italy
BACKGROUND: Aim of this study is to report the results of thromboembolectomy (ThEmb) for acute thromboembolic lower limb ischemia (ATLI) in native arteries and to create a predictive score for amputation-free survival (AFS) at 30 days.
METHODS: It is a single center, retrospective analysis of a four years period. All patients had ThEmb: adjunctive procedures included femoral and/or popliteal endarterectomy in 30 (18.3%) cases, PTA- stent in 24 (14.6%), and femoral endarterectomy plus PTA-stent in 12 (7.3%). Fasciotomies were performed in 6 (3.6%) patients. Predictors of AFS identified on univariate screen (inclusion threshold, P < .20) were included in a multivariable model. The resulting significant predictors were assigned an integer score to stratify patients into risk groups.
RESULTS: Authors analyzed 164 limbs in 164 patients. Mean age was 80 ± 10 years (range, 40-99). In-hospital mortality was 9.8% (n = 16); AFS at 30 days was 84.7% (n = 139). The anatomic level (iliac vs. femoro-popliteal vs. infrapopliteal) of the occlusion did not affect AFS (P = .326). Multivariable analysis identified six significant predictors of AFS at 30 days: age >85 (P = 0.050), chronic obstructive pulmonary disease (P = 0.008), chronic renal insufficiency (P = 0.019), late (>6 hours) onset (P = 0.004), the presence of major neurologic deficit (P = 0.023), and an increased (>800IU/L) level of creatin-phospho-kinase (P = 0.001). An integer score generated two risk groups [low-risk 0-2 (70.1% of cohort), and high-risk ≥3 (29.9% of cohort)]: stratification of the patients according to risk category yielded significantly different AFS at 30 days (low-risk 5.2% vs. high- risk 38.8%, P < 0.0001).
CONCLUSIONS: Among patients selected to undergo ThEmb for ATLI in native arteries, this risk score identified a group of patients with a 40% chance of death or major amputation at 30 days. The score can help to optimize the operative strategy but further prospective validation is needed.