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International Angiology 2011 April;30(2):172-80


language: English

Management of non-traumatic acute limb ischemia and predictors of outcome in 270 thrombembolectomy cases

Ender Topal A. 1, Nesimi Eren M. 1, Celik Y. 2

1 Department of Cardiovascular Surgery, Faculty of Medicine, Dicle University, Diyarbakir, Turkey; 2 Biostatistics Department, Faculty of Medicine, Dicle University, Diyarbakir,Turkey.


AIM: Acute limb ischemia (ALI) is one of the most potentially devastating but treatable diseases, resulting from a sudden obstruction in the arterial flow. The aim of this study was to examine the outcome of thromboembolectomy, and to determine the risk factors associated with limb loss and mortality in ALI.
METHODS: A retrospective chart review of 270 patients on whom thromboembolectomy was performed between September 2002 and December 2009 due to ALI. Of these, 146 (54.1%) were men and mean age was 64.3.
RESULTS:Etiology was embolic in 63.3% of cases. Late thromboembolectomy after 72 hours was performed in 57.8% of patients. On admission 38.9% of patients had grade IIb ischemia; grade III ischemia was present in 9.6% of patients. Failure of first thromboembolectomy developed in 21.1% of patients and bypass surgery was performed on 25.2% of patients. Amputation and mortality rates were 7.4% and 8.5% respectively. Binary logistic regression analysis revealed that risk factors of limb loss were thromboembolectomy failure, high ischemic stage, high level of plasma creatinine kinase and compartment syndrome on admission and predictors of mortality were congestive heart failure, ischemic heart disease, reperfusion injury and longer ischemic time.
CONCLUSION: In ALI, thromboembolectomy is highly protective against amputation, as well as mortality, even in delayed cases with more than one week in the clinical absence of tissue necrosis. At least, it provides partial limb salvage. In addition, patients must be given a chance for limb salvage in the case of stage 3 ischemia, too.

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