Outcome Analysis after Treatment of Acute Limb Ischemia

ABSTRACT

PURPOSE: Acute limb ischemia is not only a limb-threatening but also a life-threatening condition. Despite the use of surgical and/or thrombolytic therapy for this urgent treatment -requiring condition, it is still reported to carry high morbidity and mortality rates. METHODS: We analyzed the treatment outcomes of 118 limbs (11 upper limbs, 107 lower limb) with acute limb ischemia treated for 103 patients (age, median 64, male 89 female 14) at the Department of Surgery, Kyungpook National University Hospital, from March 1993 to March 1999. The underlying causes of acute limb ischemia included 62 limbs with acute arterial embolism in 51 patients, 39 limbs with acute arterial thrombosis in 37 patients, 15 limbs with graft occlusion in 14 patients, and 2 limbs of undetermined cause of limb ischemia in 1 patient. The retrospective, nonrandomized study was done. RESULTS: The underlying causes of acute limb ischemia were arterial embolism in 52.5%, arterial thrombosis in 33.1%, bypass graft occlusion 12.7%, and undetermined cause in 1.7%. Severity of ischemia according to the SVS/ISCVS classification, 107 limbs (90.7%) were classified as category II and 9 limbs (7.6%) were in category III. For the limbs with embolisms, 47 embolectomies (including 6 cases treated with adjuvant thrombolytic therapy) and 10 arterial bypasses were performed. For the limbs with thromboses, 23 arterial bypasses, 5 thrombectomies, and 4 catheter directed thrombolytic therapies were performed. For the patients with acute graft occusion, 8 redo bypasses, 4 thrombolytic therapies, and 2 thrombectomies were performed. We experienced major limb amputations in 8.1%, hospital mortality in 13.7% and recurrence of ischemic symptoms in 16.1% during the follow-up period in the embolism patients and limb amputations in 2.7%, hospital mortality in 14.3%, and recurrence of ischemic symptoms in 8.3% of the thrombosis patients. Of the patients with category II ischemia, major limb amputation and hospital mortality rates were 4.7% and 9.2%, respectively. CONCLUSION: In dealing with acute limb ischemia, prompt and appropriate selection of treatment modalities, if needed in combined modes, is critically important in improving the treatment outcomes.