Management of Acute Peripheral Arterial Occlusion

ABSTRACT

PURPOSE: Treatment modalities of acute limb ischemia have evolved over the last decades, but the morbidity and mortality of the disease still remains high. We performed a retrospective study to analyze the demographics, risk factors, and prognosis of this disease. METHOD: Our subjects included a total of 49 patients (55 limbs) with acute peripheral arterial occlusion who underwent operative procedures between September 1996 and August 2001 at Gil Medical Center. Cases with graft occlusion or blue toe syndrome were excluded. The SVS/ISCVS reporting standards was used. RESULT: Mean age was 64.2 years (range 25~85) and male-to-female ratio was 1.7 1. Clinical categories of ischemia were classified as the following Viable (I) in 10 cases, Marginally threatened (IIa) in 14, Immediately threatened (IIb) in 17, and Irreversible (III) in 8. There were 40 lower extremity and 8 upper extremity arterial occlusions, and 1 aortic occlusion. The causes of occlusion were thrombosis in 14 and embolism in 35. Thromboembolectomy was performed in 42 cases, bypass graft in 9, primary amputation in 7, thrombolysis in 1, and stent insertion in 1. The 30-day mortality rate was 8%, mainly due to reperfusion injury and underlying cardiopathy. The 30-day major amputation rate was 23.8%. CONCLUSION: An aggressive, prompt operative management is important in saving patients with acute arterial occlusion. Higher amputation rates were related to more severe categories of ischemia at initial presentation. Patient education along with early referral and intervention will possibly reduce the amputation rate.