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

ABSTRACT

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