Acute non-traumatic thrombotic ischemia: diagnosis and strategy of management

This study includes 118 patients [131 limbs] with acute non traumatic thrombotic ischaemia of the lower extremities, constituting 41.6 percent of the total number of cases of acute ischaemia admitted during the same period of the study. The two major causes of acute thrombotic ischaemia were atherosclerosis [58.5 percent] and arteritis [39 percent] Distinction from acute embolic ischaemia was achieved on clinical grounds as well as by arteriography [only in non threatened limbs]. The plan of management of viable limbs was initial heparinisation followed by urgent exploration [of the first impalpable pulse] of threatened limbs [31.4 percent], without prior arteriography. The management of non threatened limbs was arteriography followed by surgery, in the majority of cases [71.4 percent], thrombolysis [14.3 percent], or continuation of conservative treatment [14.3 percent]. The overall results are satisfactory with a limb salvage rate of 54.6 percent, amputation rate of 29.4 percent and mortality rate of 15.9 percent

Venous injuries

The experience met with in the management of 76 cases of venous injuries [both major abdominal and extremity veins] is presented in this study. The majority of cases [52.6%] were diagnosed secondary to the associated arterial injury. 25% percent were diagnosed by the presence of excessive bleeding and nonpulsating hematoma [17.1%]. Repair of the injured veins was done in the majority of cases [89.4%] mostly by lateral suture or autogenous vein patch [46.6%]. Ligature or nonoperative management was done in 10.6% in special situations. The overall incidence of complications was low, mild oedema [[9.2%], major morbidity [11.8%] and mortality [2.6%] and occurred mainly in patients who had their veins ligated