Acute Limb Ischemia: Surgical Thromboembolectomy and the Clinical Course of Arterial Revascularization at Ankle

Shin, Ha Song; Kyoung, Kyu-Hyouck; Suh, Byoung Jo; Jun, Si-Youl; Park, Jong Kwon

doi:10.1055/s-0033-1336827

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Furthermore, a potential difficulty in differentiating between PAE and acute peripheral arterial thrombosis in patients with pre-existing PAD could be a major cause of delayed treatment in acute emboligenic occlusion [14].…”

Section: Discussionmentioning

confidence: 99%

Delayed Treatment and Missed Opportunities for Limb Salvage in Patients with Peripheral Arterial Embolism

Nasto

Kavrakov

2020

Open Access Maced J Med Sci

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BACKGROUND: The peripheral arterial embolism (PAE) is a sudden decrease in limb perfusion due to acute occlusion of peripheral artery which leads to ischemic tissue damage, that can threaten the limb of a patient and requires immediate revascularization. It is estimated that the incidence of acute limb emoblism in the general population is around 14/100,000 inhabitants per year. Accurate and timely diagnosis is crucial to salvage the patient’s limb and sometimes the patient’s life. In cases of complete arterial occlusion and absence of collateral perfusion, irreversible damage can occur within 4 to 6 hours. The fundamental definition for treatment of acute peripheral arterial embolism is revascularisation. Revascularisation is either performed endovascularly or by an open surgical approach. A suspicion of acute ischemia based on history and physical examination warrants heparin administration and vascular surgery consultation. Delays in the management of acute peripheral arterial ischemia due to an embolism are common and associated with poor limb - salvage outcomes. AIM: Our study aims to identify medical consultations and cardiovascular assessments undergone by patients in the period prior to being hospitalised, in order to evaluate for missed or delayed opportunities for diagnosis. METHODS: Retrospective cohort study, utilising the medical documentation and previous outpatiently or inhospital consultations. Adult patients undergone treatment due to peripheral arterial embolism were identified and analyzed. Patients were identified through the administrative hospital database using the International Classification of Diseases. Hospitalised patients with those medcodes between 1st January 2010 - 1st March 2020 were recorded. RESULTS: Following exclusion, 424 patients (mean age 68.5 ± 5.85 years) were included. 159 patients (66.8%) had visited their family doctors or other medical specialist before admission and in all of the cases was initiated therapeutic approach. The rest of the cohort 79 patients (33.2%) presented lately due to other social reasons. The group of 159 patients that admitted lately due to medical indications - diagnostic, healthcare - administrative or treatment related problems are subject of our study. The largest group including 113 (71%) patients were treated outpatientley by vascular surgeons with preventative medications.17 patients (10.6%) were directed outpatientley to orthopaedic surgeon due to suspicion of trauma.15 patients (9.4%) were treated by their family doctors with pain relief medications. The rest of the 14 patients (8.8%) were treated by neurosurgeons or neurologists due to a suspicion of cauda eniqua and other neuropathies. The majority of the patients 108 (67.9%) were free of complains at the discharge, 11.3% of the studied cohort were with minimal post-treatment complains (numbness, coldness, absent peripheral pulsations, insignificant claudicatio). Amputation rate was 14.4%, incidence of rethrombosis 8.8% and recurrent embolism frequency around 3.7%. Death was registered in 21 cases (13.2%). CONCLUSION: The consequences of acute limb embolism such as prolonged hospitalization, major limb amputation, and/or death have a profound socioeconomic impact. Unrecognition of this vascular pathology and differential diagnosis difficulties are possibly leading factors for delayed or missed treatment.

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Section: Discussionmentioning

confidence: 99%

Delayed Treatment and Missed Opportunities for Limb Salvage in Patients with Peripheral Arterial Embolism

Nasto

Kavrakov

2020

Open Access Maced J Med Sci

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“…The disadvantage of this procedure is that this procedure can not be conducted on patients with hypersensitivity to contrast agents and renal disorders. [6][7][8] The two selected articles were analyzed based on their validity, importance, and applicability. The first article by De Donato was valid because it was designed as prospective cohort and its research subjects were selected using consecutive sampling method.…”

Section: Discussionmentioning

confidence: 99%

Outcome in Patients with Acute Limb Ischemia Post Hybrid Procedure Compared to Surgical Thrombectomy

Nugroho

Pratama

2020

JINASVS

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Introduction: Acute limb ischemia (ALI) is characterized by decreased perfusion to extremities in the form of acute ischemia and the presence of acute thrombus which may endanger the viability of the extremities. Therapeutic modalities are various including intraarterial thrombolysis with or without the help of ultrasonography and the use of thrombectomy instruments. However, due to the high morbidity and mortality rate, a new technique called the hybrid procedure is introduced. This procedure is a combination between endovascular management to correct the abnormalities with the help of angiography as well as thrombectomy surgical management, in the same time. Therefore, it is necessary to conduct a literature search related to the case we are reporting, to determine whether hybrid procedure or thrombectomy only is the best management for ALI. This study aims to determine the best management for the case being reported according to literature search and critical reviews collected from medical research database. Method: From the data collected, there was one interesting case, which is a case about acute limb ischemia, and the following operative management. Afterwards, a literature search was conducted to obtain articles related to the case, and critical review was made regarding the selected article. Results: At the end of the literature search, we found two articles which showed better outcome on hybrid procedure compared to surgical thrombectomy. Compared to the group who underwent thrombectomy, there was decreased 30-days mortality in the group who underwent the hybrid procedure (3.3% vs 4.4%, p-value 0.05), decreased incidence of amputations after 30 days (6.49% vs 13.5%, p-value 0.023), increased limb salvage (91.9% vs 82.3%, p-value 0.03, 95% CI), and decreased two-years mortality (18.7% vs 40.5%; p– value <0.001). Conclusion: Critical review on articles obtained from literature search in online database showed that the outcome hybrid procedure was better than surgical thrombectomy only. Keywords: acute limb ischemia; hybrid procedure; thrombectomy; outcome

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“…As a result of these examinations, the diagnosis of ALI can be made, and surgical intervention can be planned [ 8 ]. However, there are also suggestions that surgery after CTA is beneficial by showing the thrombus location and arterial structure more objectively [ 9 ]. In our clinic, the rate of using CT imaging in patients with suspected ALI has increased approximately four times in the last four years.…”

Section: Methodsmentioning

confidence: 99%

Investigation of the Effects of Stress Hyperglycemia Ratio and Preoperative Computed Tomographic Angiography on the Occurrence of Acute Kidney Injury in Diabetic Patients following Surgical Thromboembolectomy

et al. 2023

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Acute lower extremity ischemia (ALI) is a cardiovascular emergency resulting from embolic and thrombotic causes. Although endovascular techniques have advanced, surgical thromboembolectomy is still the gold standard. Emergency thromboembolectomy surgery involves an ischemia-reperfusion injury, which also poses a risk for acute renal injury (AKI). The stress hyperglycemia rate (SHR) has recently emerged as an important prognostic value in emergency cardiovascular events. In the present study, we aimed to analyze the impact of preoperative contrast-enhanced tomographic angiography (CTA) and the SHR value on postoperative AKI in emergency thromboembolectomy procedures in patients with insulin-dependent diabetes mellitus (DM). In this retrospective analysis, patients with DM who received emergency surgical thromboembolectomy after being hospitalized at our hospital with ALI between 20 October 2015, and 10 September 2022, were included. Patients were classified into two groups: Group 1 (N = 159), who did not develop AKI, and Group 2 (N = 45), who did. The 45 patients in Group 2 and the 159 patients in Group 1 had median ages of 59 (39–90) and 66 (37–93), respectively (p = 0.008). The percentage of patients in Group 2 with Rutherford class IIB and admission times longer than 6 h was higher (p = 0.003, p = 0.027, respectively). To determine the variables affecting AKI after surgical embolectomy procedures, multivariate logistic regression analysis was used. In multivariate analysis Model 1, age > 65 years (odds ratio [OR]: 1.425, 95% confidence interval [CI]: 1.230–1.980, p < 0.001), preoperative high creatinine (OR: 4.194, 95% CI: 2.890–6.156, p = 0.003), and Rutherford class (OR: 0.874, 95% CI: 0.692–0.990, p = 0.036) were determined as independent predictors for AKI. In Model 2, age > 65 years (OR: 1.224 CI: 1.090–1.679, p = 0.014), preoperative high creatinine (OR: 3.975, 95% CI: 2.660–5.486, p = 0.007), and SHR (OR: 2.142, CI: 1.134–3.968, p = 0.003), were determined as independent predictors for amputation. In conclusion, when an emergency thromboembolectomy operation is planned in insulin-dependent DM patients, renal risky groups can be identified, and renal protective measures can be taken. In addition, to reduce the renal risk, according to the suitability of the clinical conditions of the patients, the decision to perform a CTA with contrast can be taken by looking at the SHR value.

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Acute Limb Ischemia: Surgical Thromboembolectomy and the Clinical Course of Arterial Revascularization at Ankle

Cited by 3 publications

References 12 publications

Delayed Treatment and Missed Opportunities for Limb Salvage in Patients with Peripheral Arterial Embolism

Delayed Treatment and Missed Opportunities for Limb Salvage in Patients with Peripheral Arterial Embolism

Outcome in Patients with Acute Limb Ischemia Post Hybrid Procedure Compared to Surgical Thrombectomy

Investigation of the Effects of Stress Hyperglycemia Ratio and Preoperative Computed Tomographic Angiography on the Occurrence of Acute Kidney Injury in Diabetic Patients following Surgical Thromboembolectomy

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