EMBOLECTOMY FOR ACUTE LOWER LIMB ISCHEMIA

In this prospective descriptive study, all patients with acute lower limb ischemia who presented to Shohada Tajrish Hospital (STH) between July 2001 and July 2003 were analyzed and followed for 6 months. The total population of 109 patients, with no significant difference in sexual distribution had a mean age of 64±16 years. 23% had AF and 31% had a history of MI, but in the ECG of 30%, no pathologic finding had been detected. Pain and coolness were the two most prevalent symptoms. Only one-third of the patients had normal sensory and motor examination in their limb and the rest had different degrees of impairment. More than 70% of the patients arrived here after 12 hours from the onset of the symptoms. Fasciotomy was done in 29%, and amputation in 23.5%. The mortality rate was 12.2%. Surgical site infection occurred in 11% and 14.1% underwent re-embolectomy. There was no pseudoaneurysms. The time interval from the onset, sensory and motor findings, and calf tenderness a! ffected the prognosis. Prognosis was better in smokers. The iatrogenic group which consisted of 13.7% of our patient population had the best prognosis (no mortality or morbidity). 4% of the patients who had first undergone embolectomy in other centers, all lost their limbs. In cases of late embolectomies, venotomy and heparin flush has lowered the amputation level without increasing mortality. Early referral by a cardiologist, receiving heparin rapidly and smoking are among the factors which improve prognosis.