Demographic and echocardiographic predictors of anatomic site and outcomes of surgical interventions for cardiogenic limb emboli.
We sought to determine if symptomatic cardiogenic limb emboli have a random distribution or if there are demographic or echocardiographic factors that predict site of embolization, limb salvage and mortality. Upper (UE) and lower extremity (LE) emboli were evaluated over a 16-year period (1996-2012). Demographic (age, gender, smoking, medical comorbidities) and echocardiographic data were analyzed to determine predictors of embolic site. All symptomatic patients underwent surgical revascularization. Limb salvage and mortality were compared with Kaplan-Meier analysis. A total of 161 patients with symptomatic cardiogenic emboli were identified: 56 UE and 105 LE. The female-to-male ratio for UE emboli (70%:30%) was significantly higher than for LE emboli (47%:53%, p=0.008). No other demographic factors were statistically different. Upper extremity patients were more likely to have atrial fibrillation (50% vs 29.8%, p=0.028), while LE patients had a higher percentage of aortic or mitral valvular disease or intracardiac thrombus (71.4% vs 52.5%, p=0.038). The 30-day limb salvage was higher for UE compared to LE (100% vs 88%, p=0.008). There was a trend toward higher 30-day mortality in the LE group (14% vs 5%, p=0.11). Survival at 1, 3, and 5 years were similar (UE: 62.2%, 44.2%, 35.3%; LE: 69.1%, 47.5%, 30.3%; p=ns). Upper extremity emboli are more frequent in women and patients with atrial fibrillation. Lower extremity emboli are more frequent in the presence of valvular disease or intracardiac thrombus, and are associated with increased 30-day limb loss and mortality. These findings suggest gender- and cardiac-specific differences in patterns of blood flow leading to preferential sites of peripheral embolization.
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA landryg@ohsu.edu.
Gregory J
GJ
Landry
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
Rakendu
R
Shukla
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
Auddri
A
Rahman
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
Amir F
AF
Azarbal
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
Erica L
EL
Mitchell
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
Timothy K
TK
Liem
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
Gregory L
GL
Moneta
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D015897:Comorbidity; D016208:Databases, Factual; D004452:Echocardiography; D004617:Embolism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D006349:Heart Valve Diseases / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013927:Thrombosis / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*
cardiogenic emboli; embolism; heart valve diseases; peripheral vascular; retrospective studies