Acute limb ischemia: delayed presentation and outcome

ABSTRACT

Acute limb ischemia still represents an important dangerous situation in vascular surgery. Delayed presentation of acute ischemia usually leads to catastrophic outcome. Late ischemia represented 20.4% of all cases of acute limb ischemia admitted to our hospital during one year period. We were aiming to evaluate such cases with acute prolonged limb ischemia identifying causes of delayed presentation and its imprint on patients limb and life. Forty-five patients [45 limbs] were included in this study. There were 25 females and 20 males with ages ranged between 20 and 85 years [mean; 58 years]. The lower limbs were affected in 91.1% of cases while the upper limbs were involved in 8.9%. Sixty percent of cases had embolic ischemia while 40% suffered from thrombotic ischemia. The average ischemic interval was 6.8 days. Methods of treatment included medical and/or surgical intervention. Doctors of other specialties were responsible for delayed presentation in 62.2% of cases because of wrong diagnosis or treatment. Patients themselves were blamed in 31.1% of cases due to ignorance or low socioeconomic level. Long distance from the nearest specialty hospital was the cause of delay in 6.7% cases. Overall, a good outcome was recorded in 11.1% patients. Major amputation was ultimately required in 71.1% patients. Death occurred in 4.5% patients. Treatment of acute prolonged limb ischemia is difficult and results in high morbidity. Proper management of acute limb ischemia requires educational programs for genior doctors, patients and community to realize its causes, manifestations, methods of diagnosis, and importance of time factor and its imprint on patient's limb and life