title: Clinical distinction of acute and acute on chronic leg ischaemia.
abstract: The importance of the distinction between acute embolic ischaemia and acute on chronic ischaemia caused by a thrombus superimposed on an arteriosclerotic stenoses has been emphasized during the recent years, as the differentiation should affect the choice of surgical treatment. A retrospective attempt was made to differentiate between acute ischaemia (AI = embolism) and acute on chronic ischaemia (AOCI = thrombosis) of the leg by categorizing the patients according to the clinical characteristics they presented. The material consisted of 194 ischaemic lower limbs of 189 patients who underwent a balloon-catheter thromboembolectomy because of sudden arterial occlusion. The retrospective diagnosis of AI was made in 94 (48%) and AOCI in 69 (36%) cases. The preoperative assessment could not be done in 43 (22%) patients by surgeon working at the emergency room. The retrospective distinction was impossible in 31 (16%) patients. The preoperative diagnosis was in better agreement with the retrospective category when AI, as opposed to AOCI, was the aetiology of occlusion (70% vs 46%). The results of the present study emphasize the difficulties of clinical assessment. These findings suggest a routine angiography as an evaluative tool in the planning of optimal management especially as most of the patients today can be treated simultaneously by thrombolysis.
authors.affiliation: Fourth Department of Surgery, Helsinki University Central Hospital, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Kauhanen
authors.forename: T
authors.initials: T
authors.lastname: Peräkylä
authors.forename: M
authors.initials: M
authors.lastname: Lepäntalo
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D002908:Chronic Disease; D003937:Diagnosis, Differential; D017128:Embolectomy; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017131:Thrombectomy; D013923:Thromboembolism / Q000150:complications / Q000175:diagnosis / Q000601:surgery