title: Limb ischemia: surgical therapy in acute arterial occlusion.
abstract: Mortality and amputation rates from acute arterial occlusion are reported from 7 to 37 per cent and 10 to 30 per cent, respectively. Recent data from thrombolysis or peripheral arterial surgery suggest no significant differences between initial management with surgical or thrombolytic therapy. Mortality and amputation rates were in the above ranges. The last 230 procedures (216 patients) over 10 years were reviewed. All graft occlusions, cardiac catheterization injuries, and aortic balloon-related thromboses were excluded. Immediate and delayed amputation rates were 6.5 and 0.9 per cent. Death occurred in 21 patients (9.7%), with only 6 deaths over the last 6 years (3.8%). Except for transesophageal echocardiography, perioperative studies were of limited value. Long-term anticoagulation was also not effective in preventing recurrent episodes. A mortality rate of 9.7 per cent and amputation rate of 7.4 per cent justifies an early aggressive surgical approach. Limited perioperative studies and less prolonged anticoagulation may also improve cost containment.
authors.affiliation: Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37212-3735, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Neuzil
authors.forename: W H
authors.initials: WH
authors.lastname: Edwards
authors.forename: J L
authors.initials: JL
authors.lastname: Mulherin
authors.forename: R S
authors.initials: RS
authors.lastname: Martin
authors.forename: R
authors.initials: R
authors.lastname: Bonau
authors.forename: S J
authors.initials: SJ
authors.lastname: Eskind
authors.forename: T C
authors.initials: TC
authors.lastname: Naslund
authors.forename: W H
authors.initials: WH
authors.lastname: Edwards
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001132:Arm / Q000098:blood supply* / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D003131:Combined Modality Therapy; D017548:Echocardiography, Transesophageal; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D013923:Thromboembolism / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging; D016896:Treatment Outcome