Changing patterns in the etiology of acute lower limb ischemia.
OBJECTIVE
The aim of this study was to examine the causes of acute lower limb ischemia (ALLI) in a major referral center in Greece.


METHODS
Hospital records of patients that were admitted with ALLI between January 1, 2000 and December 31, 2004, were retrospectively reviewed for this purpose. A total of 440 cases of ALLI in 351 patients were identified.


RESULTS
In 174 (39.54%) cases, the ischemia was attributed to embolism; in 221 (50.23%) to thrombosis and in the remaining 45 (10.23%) to less common causes of ALLI (trauma [iatrogenic and non], vasculitis, dissection). Of 174 cases of embolism, 136 (78.16%) were of cardiac origin, 22 (12.64%) were due to non-cardiac emboli, while in the remaining 16 cases (9.2%) no specific origin of embolism was found. Of 221 cases of thrombosis 66 (29.86%) concerned native arterial thrombosis, while 155 (70.14%) concerned postinterventional thrombosis, including 144 (65.16%) cases of bypass graft thrombosis and 11 (4.98%) cases of iliac or femoral stent thrombosis. Sixty patients were admitted more than once with ALLI, most commonly due to repeated bypass graft thrombosis (85%). The latter was diagnosed in 32.73% of all ALLI cases and presented more often than native arterial thrombosis by a ratio of approximately 2.2:1.


CONCLUSIONS
This study indicates that currently the leading cause for hospital admissions in patients with ALLI is thrombosis which most commonly occurs in bypass grafts rather than in native arteries.
Klonaris
C
C
Vascular Division, 1st Department of Surgery, Athens University Medical School, Athens, Greece. chris_klonaris@yahoo.com
Georgopoulos
S
S
Katsargyris
A
A
Tsekouras
N
N
Bakoyiannis
C
C
Giannopoulos
A
A
Bastounis
E
E
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000453:epidemiology; D004617:Embolism / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006083:Graft Occlusion, Vascular / Q000150:complications* / Q000453:epidemiology; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000150:complications* / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014657:Vasculitis / Q000150:complications; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology