When is urgent revascularization unnecessary for acute lower limb ischaemia?
OBJECTIVE
To predict the risk of gangrene by the use of simple clinical parameters available on admission.


METHODS
Retrospective comparison using logistic regression and chi2 analyses of prospectively registered data from two patients series.


METHODS
One group of patients with acute lower limb ischaemia, (n = 61) was managed by selective initial non-operative treatment (NO) in a university hospital. The other group (n = 173) contained patients managed by early revascularisation in a multicentre (MC) study from 10 university, county and district hospitals. Gangrene and death within one month were recorded.


RESULTS
57% of patients in the NO group were initially managed by intravenous heparin followed by surgery when necessary. Impaired motor function and skin cyanosis in the ischaemic limb predicted gangrene. Patients without this combination were low risk (LR) patients and constituted 62% (NO) and 67% (MC). Non-operatively managed LR patients did not develop gangrene, whereas 14% of those undergoing early revascularisation in the two series did (p < 0.05).


CONCLUSIONS
The results suggest that patients without motor disturbance and cyanosis are at low risk of gangrene and may benefit from initial non-operative treatment, irrespective of the presumed aetiology.
Jivegård
L
L
Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Bergqvist
D
D
Holm
J
J
D000208:Acute Disease; D000368:Aged; D004630:Emergencies; D005260:Female; D005734:Gangrene / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures