Functional Outcome of Surgical Management for Acute Lower Extremity Ischemia

ABSTRACT

PURPOSE: Despite simplification of operative techniques, high morbidity and mortality of patients presenting with acute lower extremity ischemia remain a challenge to the vascular surgeon. The purpose of this study is to assess the functional outcome of thromboembolectomy in acute lower extremity ischemia in addition to the technical success. METHOD: A retrospective review was conducted on 52 procedures in 42 patients presenting with acute lower extremity ischemia due to arterial thrombosis or embolism between Jan. 1992 and Feb. 2000, initially underwent thromboembolectomy. After initial thromboembolectomy, we assessed the functional outcome of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997. RESULT: There were 35 men and 7 women, the mean age was 64.5 years. Mortality rate was 16.7% and overall amputation rate was 16.7%, major and minor amputation rate were 28.5% and 4.8% respectively. Causes of acute lower extremity ischemia were embolic occlusion (26.9%), native arterial thrombosis (36.5%) and bypass graft thrombosis (36.5%). Underlying diseases were heart disease (48.1%), hypertension (23.1%), cerebrovascular accident (17.3%) and diabetes (11.5%). The sites of native arterial occlusion were aortoiliac (24.2%) and distal to femoral (75.8%). Clinical categories were grade I in 1.9%, IIa in 32.7%, IIb in 61.5% and III in 3.8%. The 1-month limb salvage rate was 61.9%. The functional outcomes of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997 were +3 in 30.8%, +2 in 26.9%, +1 in 26.9%, 0 in 0.0%, +1 in 0.0%, +2 in 3.8% and +3 in 11.5%. CONCLUSION: Surgical approach to the management of acute lower extremity ischemia due to thromboembolism can achieve a significant rate of limb salvage. A new scale for gauging changes of clinical status in acute lower extremity ischemia is required to assess the functional outcome of the treatment of acute lower extremity ischemia.