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Objective To investigate the management of acute limb ischemia.Methods The clinical data of 28 patients with acute limb ischemia were retrospectively analyzed.Four patients with arterial embolism underwent embolectomy.one patient with pseudoaneurysm underwent false aneurysm resection and revascularization with PTFE,23 patieuts wiht arterial occlusive disease were treated by multiple means such as embolectomy,bypass,primary amputation,endovascular interventions,and pharmacologic therapy(n=23).Results The 5 patients with arterial embolism or pseudoaneurysm were all treated successfully.In the 23 patients with arterial occlusive disease,5(21.7%) were treated successfully,12(52.2%) were improved,and 6(26.1%) had ineffective treatment.No inpatient died,but 4 patients underwent amputation.During follow-up of 6-45 months,there were 4 deaths and other 5 amputations.Conclusions Proper intervention of patients with acute limb ischemia should be chosen according to clinical evaluation of the illness,and includes embolectomy and revascularization,to get limb or life salvage.
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Objective To explore the methods and the effect of the surgical treatment of patients with chronic ischemia of extremities.Methods In recent 6 years,the clinical data of 75 patients,including 7 upper(extremities) and 71 lower extremities with chronic ischemia,treated surgically were reviewed retrospectively.The surgical treatment included: traditional operation in 65 cases,interventional surgery in 4 cases and stem cell transplantation in 6 cases.Results Sixty-three patients(66 extremities) were followed up from 2 to 56 months after the surgical treatment,and the result showed that 9 extremities of 8 patients were amputated(within) 1 year(13.6%).In the other cases(83.3%),the ischemic symptoms were relieved or(disappeared),the ulcer healed or the amputating level had lowered(3.0%).The effective rate of the surgical treatment was 86.3%.Conclusions The appropriate surgical treatment of chronic ischemia limbs should be choiced based on the ischemic state of the limb,and a satisfactory result can be obtained in most patients.
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Objective To evaluate the outcome of composite sequential bypass in treatment of chronic lower extremity ischemia.Methods The clinical data of 25 patients with chronic lower limb ischemia who underwent composite sequential bypass reconstruction,in a 3-year period,were retropectively analyzed.The composite vessel consisted of PTFE vassular prosthesis and autologous vein.The proximal end of PTFE was anastomosed to the common femoral artery,and the distal end to the isolated popliteal artery.The autologous vein exited from the lower end of PTFE vessel and was anastomosed to the tibial or peroneal artery in the leg.Results The venous reconstructions had the inflow taken from the distal PTFE artery(above knee in 5 and below knee in 20).The outflow involved the peroneal artery in 12(48%),the posterior tibial artery in 8(32%),and the anterior tibial artery in 5(20%).Primary patency,secondary patency and limb salvage were 61%,68% and 73% at 3 year,respectively.Conclusions Composite sequential reconstruction using an isolated popliteal segment as supporting point for the distal reconstruction has high long-term patency rate and good effect of limb savage,it is an acceptable option in patients presenting with serious limb ischemia without enough venous conduit for distal bypass.
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Objective To evaluate the effective treatment for and prevention of complications. Methods The diagnosis and treatment of 32 patients with acute arterial ischemia of the lower extremity were analyzed (retrospectively). 4 cases were treated with thrombolytic therapy, 28 cases underwent emergency operation, of which 3 cases underwent amputation after embolectomy, and 25 cases were treated by arteriotomy of femoral artery and embolectomy with Fogarty catheter(7 cases underwent concomitant arterioplasty).Results One (patient) in the nonoperative group died; but there was no mortality in the operated group. Limb amputation was done in 3 cases, and limbs were saved in 28 cases. Conclusions For acute arterial ischemia of the lower (extremity), emergency arteriotomy of femoral artery plus embolectomy is the treatment of choice. This (therapeutic) approach can lower mortality and limb amputation rate.