THE OUTCOME OF ACUTE THROMBOEMBOLIC ARTERIAL OCCLUSION
Basrah Journal of Surgery,
2014, Volume 20, Issue 1, Pages 19-25
AbstractThe objective of this study was to evaluate the outcome of acute thromboembolic arterial occlusion of extremities regarding time, type of presentation and the management plane with subsequent complications after surgery. A retrospective study done on 260 patients were admitted to Al-Sader teaching hospital with signs and symptoms of acute thromboembolic arterial occlusion from January 2005 to January 2012. Patient’s age ranged from 20-85 years, 73%of them are above 50 years, males constitute (56%) and females (44%) of the patients. The onset of symptoms was sudden in 70% and gradual in (30%), only 78 patients had history of claudication. The upper limb involved in (26%) and lower limb (74%). Heart was the source of emboli in 70% while peripheral arterial atherosclerosis in 30%. One hundred eighty two patients presented with sudden onset occlusion, patients with clear source of embolism and those with no history of claudication were treated with embolectomy while patients with more gradual onset over 24hours were treated with heparin and the limb status assessed regularly. Of the patients, 46.7% were operated upon within 6 hours of the onset of symptoms, 28.6% were operated on later than 24 hours of onset of symptoms, and overall limb salvage was 83%. Amputations were necessary in 27 patients. Complications occurred in 50 patients. Twenty five patients had wound complications, most frequently wound infection. Hospital mortality was 8.2%. Over half of the total numbers of deaths were resulted from myocardial infarction (50%). Seventy eight patients with acute on chronic ischemia were treated conservatively with heparin, 60.3% responded to heparin therapy and showed a good result, 35.9% had amputation & 3.8% died during the course of treatment. In conclusion, the time of presentation is important factor in determining the outcome after surgery regarding limb survival, functional state and even mortality. Late embolectomies, although associated with increased morbidity and mortality can be done as an effective method for saving the limbs providing that the limb is still viable. Patients with acute arterial thrombosis with a viable limb can be treated with anticoagulation alone and the surgical procedure can be deferred.
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