Clinical ResearchAdverse Events after Treatment of Patients with Acute Limb Ischemia
Introduction
Acute limb ischemia (ALI) generally occurs after an acute arterial occlusion of an extremity mostly because of an arterial embolism or thrombosis.1, 2 Accurate and adequate clinical recognition is essential to improve limb salvage, reduce morbidity, mortality, and to maintain quality of life.3
Surgical thromboembolectomy has been the standard procedure for ALI for a long period.4 Since the last 2 decades, intra-arterial thrombolysis demonstrated comparable outcome results to thromboembolectomy5, 6, 7, 8, 9 and has become the preferred choice of treatment in patients with ALI.3
Arguments for thrombolysis instead of surgery were the less-invasive character of the treatment with decreased risk of perioperative adverse events (AEs). However, reports about postprocedural AEs of both procedures are in our opinion scarce, outdated, and mostly focused on hemorrhages.10, 11
AEs are one of the key issues in outcome measurement resulting in prolonged hospital stay and/or reinterventions, eventually leading to increased health care costs.12 Outcome measures are important because intra-arterial thrombolysis is considered to be a relatively safe procedure, although the indications for intra-arterial thrombolysis and thrombectomy are different.
The aim of this study was to assess the occurrence and consequences of AEs after both procedures. Secondary outcome parameters were patency and limb salvage.
Section snippets
Patients
All consecutive procedures performed in patients with ALI were retrieved from a database based on operation codes corresponding to intra-arterial thrombolysis or thrombectomies between January 2008 and December 2012. The included procedures were divided into 2 groups; group I: patients treated with intra-arterial thrombolysis and group II: patients treated with thromboembolectomy. Combined procedures (thrombolysis and/or thrombectomy followed by other vascular procedures), procedures performed
Patients
A total of 238 procedures, performed on 191 patients, were included to this study: 173 intra-arterial thrombolytic procedures (70%: group I) and 65 thromboembolectomies (30%, group II; Table I). These procedures were performed on 145 men (61%) and 93 (39%) women with a mean age of 69 ± 12.0 years.
Risk Factors and Comorbidities
Most procedures were performed on ASA-2 patients (n = 140; 59%). In group I, significantly more procedures were performed in male patients and patients with diabetes (P < 0.05). Thromboembolectomies
Discussion
Results from this present study demonstrate no superiority of intra-arterial thrombolysis on patency or amputation rates after 1-year follow-up. There was a considerable amount of AEs registered, which mostly were procedure related. Surgical reinterventions were the most frequently observed consequence of both treatments (group 1: 35% and group II: 49%). Irreversible physical damage was observed in 15% in group I and 25% in group II. Six percent of the AEs resulted in death in group I and 12%
Conclusions
ALI is a serious clinical condition with high change of morbidity and mortality. Both intra-arterial thrombolysis and thromboembolectomies are adequate therapies but result in a wide variety of AEs resulting in serious morbidity and even death.
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Cited by (7)
High Rates of Recurrent Revascularization in Acute Limb Ischemia – A National Surgical Quality Improvement Program Study
2022, Annals of Vascular SurgeryCitation Excerpt :Open and endovascular techniques are both viable options in treatment of ALI; however, even in the setting of timely intervention, ALI is associated with 30-day amputation and mortality rates as high as 30% and 11.5% respectively.4,6–10 In addition, ALI patients are at high risk of repeat thrombosis requiring 1-year reintervention approaching 30–40% in some series.11–16 ALI is being viewed as an increasingly relevant clinical trial endpoint in peripheral arterial disease (PAD) and dire complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).17–21
Results of the Surgical Management of Acute Limb Ischemia in the Nonagenarians
2021, Annals of Vascular SurgeryCitation Excerpt :In 2013, Galzerano et al.10 reported in 2013 a high success rate after vascular surgery in elderly patients (88.9%) and an encouraging low death rate of 5.9% at 1 month and 23.5% at 1 year, but the limited number of cases of their study (15 cases) make difficult any extrapolation. Concerning the surgical techniques, our practices are in agreement with several recent publications showing that all the current procedures are of equal efficiency to manage ALI and should be chosen according to the type and aspect of the lesion, its cause, its location, its clinical repercussion,26–28 but also according to the general condition of the patient.29 Our assumed strategy was to privilege less invasive procedures (Fig. 1), including 65.0% of surgical thrombectomies, 22.9% of isolated endovascular treatment, and only 9.6% of conventional bypass procedures.
Acute arterial vascular occlusion in an extremity: A vascular emergency
2017, Notfall und RettungsmedizinTreatment of acute lower limb ischaemia
2016, Vasa - European Journal of Vascular MedicineAcute limb ischemia: state of the art
2016, Gefasschirurgie