Perioperative outcome of acute lower limb ischaemia on the basis of the national vascular registry

Objectives:

To determine the mortality and limb salvage rate in acute lower limb ischaemia and compare the risk factors and outcome after acute embolic and thrombotic peripheral arterial occlusion.

Design:

Retrospective, multicentre clinical study.

Setting:

24 Departments of Surgery in Finland.

Materials:

509 patients treated for acute lower limb ischaemia 1991–1992 as recorded in the Finnish national vascular registry (FINNVASC).

Chief outcome measures:

Major amputation and death.

Main results:

Previous major amputation or vascular surgery and smoking were found to be risk factors in patients with acute thrombosis (p < 0.001). The overall amputation rate was 16% during the postoperative period. The amputation rate in patients with acute thrombosis was 26% and in those with embolism 10% (p < 0.001). Overall mortality was 13%, in patients with thrombosis 16% and 11% in patients with embolism (p = 0.07). In a separate analysis of patients with acute thrombosis, major amputation was more common after thromboembolectomy than after reconstruction (p = 0.007).

Conclusion:

The rate of major amputations and mortality were higher in acute thrombosis. The high amputation rate in this group was particularly associated with the need for reoperations and thromboembolectomy rather than reconstruction.