Outcomes of limb and life in patients with acute lower limb ischema presenting before and after the “golden six hours”

Authors

  • Murali Krishna Nekkanti Department of Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
  • Vivekanand . Department of Vascular Surgery, Jain Institute of Vascular Sciences, Bangalore, Karnataka, India
  • Kalkunte R. Suresh Department of Vascular Surgery, Jain Institute of Vascular Sciences, Bangalore, Karnataka, India
  • Vishnu Motukuru Department of Vascular Surgery, Jain Institute of Vascular Sciences, Bangalore, Karnataka, India
  • Sumanthraj Kolalu Department of Vascular Surgery, Jain Institute of Vascular Sciences, Bangalore, Karnataka, India
  • Aadarsh Kabra Department of Vascular Surgery, Apex Hospital, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20182498

Keywords:

Acute limb ischemia, Revascularization, Thromboembolectomy

Abstract

Background: Acute limb ischemia (ALI) is any sudden decrease in limb perfusion causing a potential threat to limb viability. It is generally accepted that in a patient without underlying arterial disease who develops an acute arterial blockage has approximately six hours for revascularisation before irreversible damage occurs. This study endeavoured to analyse and evaluate the causes and clinical outcome of acute lower limb ischemia.

Methods: 80 successive patients visiting Jain Institute of Vascular Sciences, Bangalore who were diagnosed to have ALI were included in this prospective study. Thromboembolectomy was performed in 48% of patients, 9% of patients were managed with anticoagulation alone, 8% of patients were treated by catheter directed thrombolysis and primary amputation was inevitable in 16 patients of class III ischemia.

Results: All the five patients who presented within the golden six hours survived and their limbs could be salvaged without any morbidity. Even in patients with delayed presentation but viable limb (47 patients) functional limb salvage was possible in 39 patients (82.9%). Overall there was 72.73% limb salvage and 27.27% patients underwent amputation. There was a mortality rate of 13.16% in the study.

Conclusions: Overall there was 72.73% limb salvage and 27.27% patients underwent amputation. Revascularization within six hours is ideal (only 6.25% of patients in our study); however, in delayed presentation (93.75%), physiological state of the limb, rather than elapsed time from onset of occlusion will determine the operability. Late revascularization may thus be indicated and is often successful if limb still exhibits signs of viability.

References

Byrne J. Etiology and natural history: diagnosis and evaluation. Comprehensive vascular and endovascular surgery. Chap Mosby;15(4):197-212.

Blaisdell FW, Steele M, Allen RE. Management of acute lower extremity arterial ischemia due to embolism and thrombosis. Surg. 1978;84(6):822-34.

Korn P, Khilnani NM, Fellers JC, Lee TY, Winchester PA, Bush HL, et al. Thrombolysis for native arterial occlusions of the lower extremities: clinical outcome and cost. J Vasc Surg. 2001;33(6):1148-57.

Dryjski M, Swedenborg J. Acute non traumatic extremity ischemia in Sweden- a one year survey. Acta Chir Scand. 1985;151(4); 333-9.

Ammann J, Seiler H, and Vogt B. Delayed arterial embolectomy; a plea for a more active surgical approach. Br J Surg. 1976;63(1):73-6.

Mac-Gowan WAL, Mooneram R. A review of 174 patients with arterial embolism. Br J Surg. 1973;60(11):894-8.

Hammarsten J, Holm J, Schersten T. Positive and negative effects of anticoagulant treatment during and after arterial embolectomy. J Cardiovasc Surg. 1978;19(4):373-8.

Thompson JE, Sigler L, Raut PS, Austin DJ, Patman RD. Arterial embolectomy: a 20 year experience with 163 cases. Surg. 1970;67(1):212-20.

Levin BH, Joseph M. Giordano. Delayed arterial embolectomy. Surg. Gynaecol Obst. 1982;155(4):549-51.

Downloads

Published

2018-07-23

Issue

Section

Original Research Articles