title: Arterial emboli of the lower limbs: analysis of risk factors for mortality and amputation. Association Universitaire de Recherche en Chirurgie.
abstract: To evaluate risk factors for mortality and amputation after arterial embolism of the lower limbs, we reviewed the records of 397 patients (201 men [mean age 69 +/- 14 years] and 196 women [mean age 79 +/- 12 years]) who were enrolled in a prospective study. The degree of ischemia was rated as follows: grade I in 26% of patients, grade II in 46%, and grade III in 27%. Among patients with complete obstruction, the emboli were located above the inguinal ligament in 213 limbs (46%), in the superficial or popliteal artery in 196 (43%), and at the infrapopliteal level in four (3%). The emboli were bilateral in 59 cases (15%). In 11% of patients the emboli also involved either an upper limb or a visceral or cerebral artery. The origin of the embolus was the heart in 55% of patients, an artery in 12%, and was unknown in the remaining cases. Two hundred two patients (50%) had arterial fibrillation, 33 (8%) had cardiac conduction abnormalities, 186 (47%) had ischemic heart disease, 55 (14%) had valvular heart disease, and 43 (11%) had cardiac insufficiency. The in-hospital mortality rate was 15% (n = 60) and major amputations or severe ischemic sequelae were observed in 23% (n = 91). Logistic regression analysis revealed four independent preoperative factors associated with a significantly higher risk of death: associated visceral emboli with a relative risk (RR) of 6.7 (p < 0.001), invalidism with an RR of 4.3 (p < 0.001), cardiac insufficiency with an RR of 2.4 (p = 0.001), and creatinemia > 180 ml/L with an RR of 2.1 (p = 0.01). The variables associated with an increased risk of amputation were invalidism (p = 0.001), severity of ischemia (p = 0.001), infrapopliteal location of the embolus (p = 0.001), delay of more than 12 hours before treatment of severe ischemia was initiated (p = 0.01), failure to restore arterial patency (p = 0.001), and postoperative cardiac complications (p = 0.01).
authors.affiliation: Service de Chirurgie Vasculaire, Hôpital Henri Mondor, Créteil, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Becquemin
authors.forename: S
authors.initials: S
authors.lastname: Kovarsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D004617:Embolism / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology