Clinical Outcomes Following Surgical Revascularization for Acute Lower Limb Ischemia

Authors

  • Arkom Suesawatee Department of Surgery, Phrapokklao Hospital Chanthaburi
  • Kritawit Kritayamaneerat Department of Surgery, Phrapokklao Hospital Chanthaburi
  • Thiti Wannasiri Department of Surgery, Phrapokklao Hospital Chanthaburi
  • Tanapon Supapon Department of Surgery, Phrapokklao Hospital Chanthaburi

Keywords:

Acute lower limb ischemia (ALI), Embolism, Thrombosis, Revascularization, Limb salvage

Abstract

Objectives: To assess the clinical outcomes of surgical revascularization in patients diagnosed with acute lower limb ischemia (ALI). The primary outcome was defined as the limb salvage rate within 30 days after surgery.

Methods: This is a retrospective single-center study. The target population was recruited from the Prapokklao Hospital database between January 2019 – December 2023. Patients who were diagnosed with acute occlusion of the artery according to the International Classification of Disease 10th Revision (ICD-10) code I74.0, I74.3, and I74.5 were identified. Medical records were analyzed for demography, clinical presentation, etiology, Rutherford severity classification, revascularization procedures, major amputation, mortality within 30 days after revascularization, and data during follow-up.

Results: This study enrolled a total of 70 patients, 46 men (65.71%) and 77 affected limbs. The mean age was 65.67 years (SD 13.69 years), and the median was 65 years, ranging from 19 to 94 years. Co-morbidities: 42 (60%) hypertension, 28 (40%) peripheral arterial disease, 26 (37.14%) atrial fibrillation. Etiologies: 36 (51.43%) thrombosis (34.29% in-situ thrombosis of the native vessel) and 34 (48.57%) embolism. Rutherford classification of severity categories I, IIa, and IIb was 1 (1.42%), 21 (30.0%), and 48 (68.58%), respectively. The modalities of revascularization included 70 (100 %) thromboembolectomy with a Fogarty catheter, 30 (42.86%) intra-arterial angioplasty with balloon or stent, 8 (11.43%) bypass procedure, 6 (8.57%) endarterectomy and 8 (11.42%) fasciotomy. Technical success was 98.57 %. The mean operative time was 195.07 minutes (SD 95.51 minutes). The median hospital stay was 8 days. Post-operative complications were 8 (11.43%) bleeding, 7 (10%) compartment syndrome, 5 (7.14%) reperfusion injury, 5 (7.14%) acute kidney injury, 2 (2.86%) pneumonia and 1 (1.43%) acute myocardial infarction. The 30-day major amputation rate and mortality were 10.0% and 5.71%, respectively. At 30 days, sixty-three patients (90%) had limb salvage, and Four (5.71%) patients had died.

Conclusion: Clinical outcomes following surgical revascularization for acute lower limb ischemia in our hospital showed high technical success and limb salvage rates. The limb salvage rate was 90.0%, and the mortality rate was 5.71%.

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TJS 45-2 02

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Published

2024-06-28

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1.
Suesawatee A, Kritayamaneerat K, Wannasiri T, Supapon T. Clinical Outcomes Following Surgical Revascularization for Acute Lower Limb Ischemia. Thai J Surg [Internet]. 2024 Jun. 28 [cited 2024 Nov. 22];45(2):36-42. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/267963

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Vol. 45 No. 2 (2024): April - June

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