Management of Acute Lower Limb Ischemia Without Surgical Revascularization – A Population-Based Study
Acosta, Stefan LU
; Kulezic, Andrea
LU
; Zarrouk, Moncef
LU
and Gottsäter, Anders
LU
(2023)
In Vascular and Endovascular Surgery
- Abstract
Objectives: To evaluate outcomes of management without surgical revascularization in patients with acute lower limb ischemia (ALI) in a population-based setting. Design: Retrospective observational population-based study. Materials: Patients from Malmö, Sweden, hospitalized for ALI between 2015 and 2018. Methods: In-hospital, surgical, radiological, and autopsy registries were scrutinized for descriptive data on ALI patients managed by endovascular and open vascular surgery, conservative vascular therapy, primary major amputation, and palliative care. Results: Among 161 patients, 73 (45.3%) did not undergo any operative revascularization. Conservative vascular therapy, primary amputation, and palliative care were conducted in 25... (More)
Objectives: To evaluate outcomes of management without surgical revascularization in patients with acute lower limb ischemia (ALI) in a population-based setting. Design: Retrospective observational population-based study. Materials: Patients from Malmö, Sweden, hospitalized for ALI between 2015 and 2018. Methods: In-hospital, surgical, radiological, and autopsy registries were scrutinized for descriptive data on ALI patients managed by endovascular and open vascular surgery, conservative vascular therapy, primary major amputation, and palliative care. Results: Among 161 patients, 73 (45.3%) did not undergo any operative revascularization. Conservative vascular therapy, primary amputation, and palliative care were conducted in 25 (15.5%), 26 (16.1%), and 22 (13.7%) patients, respectively. Conservatively treated patients had Rutherford class ≥ IIb ischemia and embolic occlusion in 33% and 68% of cases, respectively. Their median C-reactive protein level at admission was 7 mg/L (interquartile range 2 – 31 mg/L). Among conservatively treated patients, anticoagulation therapy in half to full dose was given to 22 (88%) patients for six weeks or longer, and analgesics in low or moderate doses were given to twelve (48%) patients at discharge. The major amputation rate at 1 year was 8% among conservatively treated patients, and four patients with foot embolization had not undergone amputation at 1 year. Conclusion: Patients selected for initial conservative therapy of ALI with anticoagulation alone may have a good outcome, even when admitted with Rutherford class IIb ischemia. A low C-reactive protein level at admission seems to be a favorable marker when choosing conservative therapy. A prospective, preferably multicenter, study with a predefined protocol in these conservatively treated patients is warranted to better define the dose and length of anticoagulation therapy.
(Less)
- author
- Acosta, Stefan
LU
; Kulezic, Andrea
LU
; Zarrouk, Moncef
LU
and Gottsäter, Anders
LU
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- acute lower limb ischemia, anticoagulation, conservative therapy, major amputation, population-based study
- in
- Vascular and Endovascular Surgery
- publisher
- SAGE Publications
- external identifiers
-
- pmid:37941090
- scopus:85176382803
- ISSN
- 1538-5744
- DOI
- 10.1177/15385744231215552
- language
- English
- LU publication?
- yes
- id
- 65348914-9eab-4bb3-b2bf-b81464e1d31e
- date added to LUP
- 2024-01-11 09:31:15
- date last changed
- 2024-04-26 05:15:49
@article{65348914-9eab-4bb3-b2bf-b81464e1d31e,
abstract = {{<p>Objectives: To evaluate outcomes of management without surgical revascularization in patients with acute lower limb ischemia (ALI) in a population-based setting. Design: Retrospective observational population-based study. Materials: Patients from Malmö, Sweden, hospitalized for ALI between 2015 and 2018. Methods: In-hospital, surgical, radiological, and autopsy registries were scrutinized for descriptive data on ALI patients managed by endovascular and open vascular surgery, conservative vascular therapy, primary major amputation, and palliative care. Results: Among 161 patients, 73 (45.3%) did not undergo any operative revascularization. Conservative vascular therapy, primary amputation, and palliative care were conducted in 25 (15.5%), 26 (16.1%), and 22 (13.7%) patients, respectively. Conservatively treated patients had Rutherford class ≥ IIb ischemia and embolic occlusion in 33% and 68% of cases, respectively. Their median C-reactive protein level at admission was 7 mg/L (interquartile range 2 – 31 mg/L). Among conservatively treated patients, anticoagulation therapy in half to full dose was given to 22 (88%) patients for six weeks or longer, and analgesics in low or moderate doses were given to twelve (48%) patients at discharge. The major amputation rate at 1 year was 8% among conservatively treated patients, and four patients with foot embolization had not undergone amputation at 1 year. Conclusion: Patients selected for initial conservative therapy of ALI with anticoagulation alone may have a good outcome, even when admitted with Rutherford class IIb ischemia. A low C-reactive protein level at admission seems to be a favorable marker when choosing conservative therapy. A prospective, preferably multicenter, study with a predefined protocol in these conservatively treated patients is warranted to better define the dose and length of anticoagulation therapy.</p>}},
author = {{Acosta, Stefan and Kulezic, Andrea and Zarrouk, Moncef and Gottsäter, Anders}},
issn = {{1538-5744}},
keywords = {{acute lower limb ischemia; anticoagulation; conservative therapy; major amputation; population-based study}},
language = {{eng}},
publisher = {{SAGE Publications}},
series = {{Vascular and Endovascular Surgery}},
title = {{Management of Acute Lower Limb Ischemia Without Surgical Revascularization – A Population-Based Study}},
url = {{http://dx.doi.org/10.1177/15385744231215552}},
doi = {{10.1177/15385744231215552}},
year = {{2023}},
}