ANALYSIS OF RISK FACTORS FOR AMPUTATION AND MORTALITY IN 504 CASES WITH ACUTE ARTERIAL EMBOLI

Background: We retrospectively examined the records of 504 patients who underwent a total of 581 operations for acute peripheral arterial occlusion of the upper or lower extremities at the Atatürk University Medical Faculty, Cardiovascular Surgery Department between 1993 and 2006. We analyzed the effects of atherosclerotic structure, the time of admission to hospital, recurrence re-embolectomies, hyperbarique oxygen theraphy, ileoprost treatment on amputation and mortality in the early postoperative period.

Methods: The patients ranged in age from 21 to 93 years old. There were 267 (% 53) men and 237 (% 44) women, with an average age of 58 years old. The time of admission to hospital was 2–168 hours (range; 52 hours). The underlying cause of arterial embolism was atrial fibrillation in most 322 (% 63,8) patients. There was lower extremity, both lower and upper extremity and upper extremity emboli in 417 (82,7 %), 5 (1 %), and 82 (16,3 %) in patients, respectively. Bypass procedures were done in 17 (% 3,3) patients. Fasciotomy, patchplasty, and endarterectomy were made in 11 (2,1 %), 4 (0,8 %) and 3 (0,6 %) patients, respectively. Additive embolectomies from posterior and anterior tibial artery and radial artery were carried out. Ileoprost and hyperbaric oxygen treatment were applied in the 10 (2,0 %) and 8 (1,6 %) patients, respectively.

Results: Early revision was performed in 77 (15,3 %) patients. Postoperative early death occurred in 21 (% 4,2) patients. Amputation was performed in 75 (14,8 %) patients. Delay after six hours from the onset of complaints increased the risk of amputation and mortality. Also re-embolectomies increased the amputation rate.

Conclusion:v If the embolectomy, which is a rapid and easy technique for treatment of acute arterial emboli, is performed by experienced surgeons without delay, the complications associated to emboli might be prevented. Otherwise, delayed operation and repeated re-embolizations in acute arterial emboli play important roles on morbidity and mortality. (Turkish J Vasc Sur 2007;16(1):5-12)