Abstract

AIM
The aim of this study was to analyze factors influencing outcomes of surgical management for lower limb acute ischemia.
METHODS
A retrospective analysis of 490 thromboembolectomies performed in 468 patients was conducted. Perioperative and follow-up results were analyzed. Univariate and multivariate analysis of clinical variables and patients' characteristics for the risk of reocclusion, amputation and mortality at 2 years were performed. Statistical significance was defined as a P value <0.05.
RESULTS
Cumulative reocclusion, amputation and mortality rates at 24 months were 22.6%, 14.3% and 42.8%, respectively. At univariate analysis, the factors associated with increased 2-year reocclusion rate were severity of clinical presentation, current smoking habit, arterial thrombosis rather than embolism, atrial fibrillation and the avoidance of completion angiography. All these factors except clinical presentation maintained significance at multivariate analysis. Factors associated with increased 2-year amputation rate at univariate analysis included severity of clinical presentation, smoke, arterial thrombosis, atrial fibrillation and valvulopathy. All these factors except clinical presentation and valvular defects maintained significance at multivariate analysis. Factors associated with increased 2-year mortality rate at univariate analysis included age >80 years, arterial thrombosis, history of peripheral arterial disease and antiplatelet drugs. The same factors, except antiplatelet treatment, were found to be significant at multivariate analysis.
CONCLUSION
Surgical intervention for lower limb ischemia is associated with high 2-year mortality but offers good 2-year limb salvage. The pattern of risk factors for reocclusion and amputation rates is quite different from those affecting mortality. Only thrombotic aetiology is a significant risk factor for all the three outcomes.

Links

Publisher Full Text

Authors

Zaraca F, Ponzoni A, Sbraga P, Ebner JA, Giovannetti R, Ebner H

Institution

Department of Vascular and Thoracic Surgery, Regional Hospital Bolzano, Bolzano, Italy. francesco.zaraca@asbz.it

Source

Minerva chirurgica 67:1 2012 Feb pg 49-57

MeSH

Acute Disease
Aged
Aged, 80 and over
Amputation
Analysis of Variance
Female
Follow-Up Studies
Humans
Ischemia
Leg
Limb Salvage
Male
Middle Aged
Multivariate Analysis
Peripheral Vascular Diseases
Reoperation
Retrospective Studies
Risk Factors
Survival Analysis
Thrombectomy
Time Factors
Treatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22361676