Elsevier

Annals of Vascular Surgery

Volume 29, Issue 2, February 2015, Pages 293-302
Annals of Vascular Surgery

Clinical Research
Adverse Events after Treatment of Patients with Acute Limb Ischemia

https://doi.org/10.1016/j.avsg.2014.10.022Get rights and content

Background

To assess the outcome and the occurrence and consequences of adverse events (AEs) after treatment of acute limb ischemia (ALI).

Methods

Retrospective analysis on intra-arterial thrombolysis (group I) and thromboembolectomy (group II). Outcome measures were primary patency and limb salvage rates. AEs and consequences were registered during admission and 30 days after discharge.

Results

A total of 238 procedures were included (group I, 173 vs. group II, 65). The primary patency (P = 0.144) and limb salvage rates (P = 0.166) were not significantly different between both groups. A total of 195 AEs were registered. Most AEs were procedure related and resulted in surgical reintervention (77% vs. 76%). Some AEs resulted in irreversible physical damage (15% vs. 25%) and death (6% vs. 12%).

Conclusions

Both, intra-arterial thrombolysis and thromboembolectomies are adequate therapies; however, they result in a wide variety of AEs resulting in serious morbidity and even death.

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 However, reports about postprocedural AEs of both procedures are in our opinion scarce, outdated, and mostly focused on hemorrhages.10, 11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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