Should embolectomy be performed in late acute lower extremity arterial occlusions?

Hikmet Iyem, M Nesimi Eren

Department of Cardiovascular Surgery, Dicle University, Diyarbakir, Turkey

Background: We analyzed the embolectomy results and complications of patients who were operated on after a diagnosis of late acute arterial occlusion of lower extremities.

Methods: A total of 122 patients operated on in our clinic between 2004 and 2009 for late acute arterial occlusion were included in the study. Late arterial occlusion was defined as occlusion occuring 72 hours after initial manifestation of the patient complaints related to the affected lower extremity.

Results: Average age of the 122 patients (71 male, 51 female) was 54.2 ± 16.8 years. In this cohort, 64.75% of patients had cardiac pathologies, while 28.68% had extracardiac causes; 1.64% patients had cathetherization, 0.81% patient had malignancy, and 2.46% patients had a history of trauma. In 1.64% of the cases, no reason for thromboembolysis could be found. Thirty-one patients (25.40%) had additional surgical operations, 14 (11.47%) had fasciotomy, and 9 (7.37%) had amputation. Re-embolectomy was performed on 37 patients (30.32%) who had ongoing ischemia after an operation. Additional surgical operations were performed on 31 patients (25.40%) with ongoing ischemia. In 14 of these cases (11.47%), patients were treated with fasciotomy due to development of compartment syndrome. Amputation was performed on a total of 9 patients. Early in the postoperative phase, mortality was observed in 11 patients (9.01%).

Conclusion: We believe that late embolectomies of acute late leg ischemia increases blood flow in the extremity and reduces the number of amputations required.

Keywords: lower extremity, embolism, prognosis, treatment outcome