Patients with Acute Lower Limb Ischemia Continue to Have Significant Morbidity and Mortality

• Published in: Annals of vascular surgery Vol. 108; pp. 127 - 140
• Main Authors: Dobesh, Kaitlyn, Natour, Abdul Kader, Kabbani, Loay S., Rteil, Ali, Lee, Alice, Nypaver, Timothy J., Weaver, Mitchell, Shepard, Alexander D.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.11.2024
• Subjects: Acute Disease; Aged; Aged, 80 and over; Amputation, Surgical; Databases, Factual; Female; Humans; Ischemia - diagnosis; Ischemia - mortality; Ischemia - surgery; Ischemia - therapy; Length of Stay; Limb Salvage; Lower Extremity - blood supply; Male; Michigan - epidemiology; Middle Aged; Patient Readmission; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - mortality; Peripheral Arterial Disease - therapy; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Michigan
• ISSN: 0890-5096; 1615-5947; 1615-5947
• DOI: 10.1016/j.avsg.2024.03.024

The treatment of acute lower limb ischemia (ALLI) has evolved over the last several decades with the availability of several new treatment modalities. This study was undertaken to evaluate the contemporary presentation and outcomes of ALLI patients. We retrospectively analyzed data from a prospectively collected database of all patients who presented to our tertiary referral hospital with acute ischemia of the lower extremity between May 2016 and October 2020. The cause of death was obtained from the Michigan State Death Registry. During the study period, 233 patients (251 lower limbs) were evaluated for ALLI. Seventy-three percent had thrombotic occlusion, 24% had embolic occlusion, and 3% due to a low flow state. Rutherford classification of ischemia severity was 7%, 49%, 40%, and 4% for Rutherford grade I, IIA, IIB, and III, respectively. Five percent underwent primary amputations, and 6% received medical therapy only. The mean length of stay was 11 ± 9 days. Nineteen percent of patients were readmitted within 30 days of discharge. At 30 days postoperatively, mortality was 9% and limb loss was 19%. On multivariate analysis, 1 or no vessel runoff to the foot postoperatively was associated with higher 30-day limb loss. Patients with no run-off vessels postoperatively had significantly higher 30-day mortality. Cardiovascular complications accounted for most deaths (48%). At 1-year postoperatively, mortality and limb loss reached 17% and 34%, respectively. Despite advances in treatment modalities and cardiovascular care, patients presenting with ALLI continue to have high mortality, limb loss, and readmission rates at 30 days.