Amputation risk and survival after embolectomy for acute arterial ischaemia. Time trends in a defined Swedish population.
OBJECTIVE
To assess the outcome of embolectomy over an 19 year period.


METHODS
Time trends in the outcome of acute arterial thrombo-embolectomy of the extremities were analysed in a population-based cohort of 1190 patients operated on between 1965-83.


RESULTS
A total of 262 (22%) initial amputations were performed. The limb salvage rates at 5 years postoperatively were lower between 1975-79 (61%) than between 1965-69 (81%). A proportional hazards model revealed a relative hazard (RH) of amputation of 2.2 (95% confidence interval (CI) 1.3-3.3) for 1975-79 compared with 1965-69. Operation at any district hospital entailed a 70% higher risk of amputation (RH 1.7; 95% CI 1.3-2.5) compared with the University hospital. The relative survival rate at 5 years postoperatively decreased towards the end of the study period (33% between 1975-79 compared with 43% between 1965-69). Younger age-groups had a considerably lower risk of death in the University hospital compared with the county and district hospitals.


CONCLUSIONS
Contrary to the results in other hospital based reports no improvement in amputation or survival rates since 1965 could be demonstrated in this large series with no patient selection.
Ljungman
C
C
Department of Surgery, Uppsala University Hospital, Sweden.
Holmberg
L
L
Bergqvist
D
D
Bergström
R
R
Adami
H O
HO
D000208:Acute Disease; D000368:Aged; D000671:Amputation, Surgical / Q000401:mortality* / Q000706:statistics & numerical data; D017128:Embolectomy / Q000401:mortality* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D008875:Middle Aged; D016016:Proportional Hazards Models; D011859:Radiography; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors