Results of treatment of acute occlusions of limb arteries at a university hospital - retrospective study
Acute arterial occlusions (AAO) in limbs have been increasing in parallel with population longevity. To assess risk factors, limb salvage rates, and survival of patients with AAO treated at a University Hospital. Retrospective cohort study of consecutive patients. Outcomes included: patency, symptom...
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| Published in: | Jornal vascular brasileiro Vol. 19; p. e20200031 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Brazil
Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
16-11-2020
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Acute arterial occlusions (AAO) in limbs have been increasing in parallel with population longevity.
To assess risk factors, limb salvage rates, and survival of patients with AAO treated at a University Hospital.
Retrospective cohort study of consecutive patients. Outcomes included: patency, symptoms, comorbidities, Rutherford category, arteries occluded, postoperative complications, and 30-day limb salvage and mortality rates.
Medical records were evaluated from 105 patients, predominantly males (65.7%), with ages ranging from 46 to 91 years. Etiology: thrombotic (54.3%), embolic (35.2%), and undefined (10.5%). About 2/3 of the patients were assessed as Rutherford category II or III. Associated symptoms: pain (97.1%), coldness (89.5%), pallor (64.7%), sensory loss (44.7%), paralysis (30.5%), anesthesia (21.9%), edema (21.9%), and cyanosis (15.2%). Associated comorbidities: hypertension (65.0%), smoking (59.0%), arrhythmias (26.6%), dyslipidemia (24.0%), and diabetes (23.8%). The distal superficial femoral-popliteal segment was the most affected (80%). Thromboembolectomy with a Fogarty catheter was performed in 73.3% of cases (81.0% of embolic cases, 71.9% of thrombotic cases, and 54.5% of cases with undefined etiology) and was the only treatment used in 41 cases (39.05%), among which there were 11 reocclusion, 20 amputations, and 14 deaths. Arterial reocclusion was more frequent in thrombosis cases (12.9%, p = 0.054). Within 30 days of treatment, total mortality was 14.6%, and 19.8% of cases underwent major amputation, which was less frequent among Rutherford Class I patients (p = 0.0179).
Treatment of AAO was primarily performed by thromboembolectomy with a Fogarty catheter, either alone or in combination with other treatments, achieving amputation and complication rates compatible with the best results in the literature and were progressively lower in less advanced Rutherford categories. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Conflicts of interest: No conflicts of interest declared concerning the publication of this article. Author information: CT - Medical student, Faculdade de Medicina de Botucatu, Cirurgia e Ortopedia, Universidade Estadual Paulista “Júlio de Mesquita Filho” (UNESP). MB - PhD, assistant professor of Cirurgia Vascular e Endovascular at Faculdade de Medicina de Botucatu, Cirurgia e Ortopedia, Universidade Estadual Paulista “Júlio de Mesquita Filho” (UNESP); MSc in Biotecnologia Médica, PhD in Bases Gerais da Cirurgia and board certified in Cirurgia Vascular e Endovascular. FPCMG - Medical student, Faculdade de Medicina de Botucatu, Cirurgia e Ortopedia, Universidade Estadual Paulista “Júlio de Mesquita Filho” (UNESP). MLS - Adjunct professor, tenured professor of Cirurgia Vascular e Endovascular at Faculdade de Medicina de Botucatu, Cirurgia e Ortopedia, Universidade Estadual Paulista “Júlio de Mesquita Filho” (UNESP); PhD in Bases Gerais da Cirurgia and board certified in Cirurgia Vascular, Cirurgia Endovascular and Ecografia Vascular com Doppler from Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV). RAY - Collaborating professor of Cirurgia Vascular e Endovascular at Faculdade de Medicina de Botucatu, Cirurgia e Ortopedia, Universidade Estadual Paulista “Júlio de Mesquita Filho” (UNESP); PhD in Bases Gerais da Cirurgia and board certified in Cirurgia Vascular, Cirurgia Endovascular and Ecografia Vascular com Doppler from Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV). RM - Adjunct professor, tenured professor of Cirurgia Vascular e Endovascular at Faculdade de Medicina de Botucatu, Cirurgia e Ortopedia, Universidade Estadual Paulista “Júlio de Mesquita Filho” (UNESP); MSc and PhD in Bases Gerais da Cirurgia and board certified in Cirurgia Vascular e Cirurgia Endovascular from Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV). RGJ – Substitute professor and primary physician of Cirurgia Vascular e Endovascular at Faculdade de Medicina de Botucatu, Cirurgia e Ortopedia, Universidade Estadual Paulista “Júlio de Mesquita Filho” (UNESP); PhD in Bases Gerais da Cirurgia and board certified in Cirurgia Vascular, Cirurgia Endovascular and Ecografia Vascular com Doppler from Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV). WBY - Full professor of Cirurgia Vascular e Endovascular at Faculdade de Medicina de Botucatu, Cirurgia e Ortopedia, Universidade Estadual Paulista “Júlio de Mesquita Filho” (UNESP); MSc and PhD in Bases Gerais da Cirurgia and board certified in Cirurgia Vascular e Cirurgia Endovascular from Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV). Author contributions: Conception and design: CT, FPCMG, RAY, WBY Analysis and interpretation: CT, MB, FPCMG, MLS, RAY, RGJ, WBY Data collection: CT, FPCMG Writing the article: CT, MB, FPCMG, MLS, RAY, RM, RGJ, WBY Critical revision of the article: CT, MB, FPCMG, MLS, RAY, RM, RGJ, WBY Final approval of the article*: CT, MB, FPCMG, MLS, RAY, RM, RGJ, WBY Statistical analysis: CT, FPCMG, WBY Overall responsibility: WBY *All authors have read and approved of the final version of the article submitted to J Vasc Bras. |
| ISSN: | 1677-5449 1677-7301 |
| DOI: | 10.1590/1677-5449.200031 |