Acute leg ischaemia--a case for the junior surgeon?
OBJECTIVE
To evaluate the change in the type of acute leg ischaemia and the outcome of its treatment in relation to the experience of the surgeon responsible for the treatment.


METHODS
A 12-year (1980-1991) retrospective study based on hospital records and population vital statistics.


METHODS
A defined population of 165,000 served by one central hospital (CH) and two district hospitals (DH).


METHODS
282 interventions performed for acute leg ischaemia.


METHODS
Type of leg ischaemia, reintervention, amputation and survival rates in relation to the type of ischaemia, treatment and surgical expertise.


RESULTS
Thrombotic acute ischaemia increased by 91% and graft occlusions by 130% while embolisation numbers remained unchanged during the period. With junior, general and vascular surgeons operating on acute ischaemia, the respective 30-day amputation rates were 25%, 18% and 9%. Postoperative mortality was 29%, 33% and 8% respectively. The reconstruction rate for the vascular surgeon was 67% with 33% thrombectomies, while the figures for junior surgeons were 2% and 98% and for senior surgeons 6% and 94%.


CONCLUSIONS
Mortality and amputation rates in acute ischaemia are high. By judicious use of different treatment modalities, as judged by vascular surgical experience, better limb salvage rates may be achieved especially in patients with acute on chronic ischaemia.
Luther
M
M
Surgical Department, Vasa Central Hospital, Finland.
Albäck
A
A
D000208:Acute Disease; D000368:Aged; D000671:Amputation, Surgical; D000792:Angiography; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000193:education