ABSTRACT
INTRODUCTION: To treat an extremity embolus seems to be a simple and safe procedure. However, it is not exempt from potentially serious complications. We review our experience of treating acute peripheral arterial occlusion due to emboli. PATIENTS AND METHOD: We retrospectively analyzed the data of 127 embolectomies performed during the last five years, in 120 extremities in 116 patients. The mean age of the patients was 80 years and 66% were female. All cases were presented as acute threatened limb ischemia grades IIA or IIB, and the mean evolution time was 27 hours. The patency, limb salvage and morbidity-mortality rates in the postoperative period and the salvage and survival rates in the follow-up were analyzed. RESULTS: Of the embolectomies, 55% were femoral and 30% brachial. Although 90% of the cases improved, only 75% of them recovered distal pulses. In the postoperative period the patency, limb salvage, morbidity and mortality rates were 90%, 96%, 13% and 6.4%, respectively. The mean follow-up was 24 months. Up until this time, the patency and survival rates are 91% and 61%, respectively. The only factor related with an increase in the amputation rate was a clinical presentation, such as a threatened immediate ischemia. The factors related with an increase in survival rate were appropriate cardiological treatment and control, and long-term anticoagulation treatment. CONCLUSIONS: Suffering an embolus of the extremities and its treatment causes considerable morbidity-mortality and limb amputation rates. The extremity salvage is associated with the clinical presentation at the time of the treatment. Long-term anticoagulation treatment and appropriate cardiological control increase the survival of these patients.
Subject(s)
Embolectomy , Embolism/surgery , Extremities/blood supply , Adult , Aged , Aged, 80 and over , Amputation, Surgical , Data Interpretation, Statistical , Female , Humans , Limb Salvage , Male , Middle Aged , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the accuracy of color Doppler-ultrasonography (CDU) compared with biopsy for the diagnosis of temporal arteritis (TA). PATIENTS AND METHOD: Twenty-three patients with suspected TA on the basis of clinical criteria were evaluated with CDU prior to temporal artery biopsy. The presence of a hypoechoic halo, suggesting edema of the inflamed vessel, and inflammatory stenoses were registered. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and eficiency or global test value (GTV) were evaluated. RESULTS: All patients completed a bilateral CDU examination of temporal arteries, and in 72% of patients the biopsy was negative for TA. When the presence of an halo in CDU examination was regarded as determinant for disease, sensitivity, specificity, PPV, NPV and GTV compared with TA histologic confirmation were 80%, 92%, 80%, 92% and 88%, respectively. When the criteria used was presence of the halo sign with or without inflammatory stenosis, the values were 100%, 77%, 62.5%, 100% and 83% respectively. CONCLUSIONS: Because of the high sensitivity and NPV, we consider CDU as a good screening test for the diagnosis of TA.
