Clinical Features of Chronic Lower Limb Ischemia

Oh, Jun Hyup; Kwun, Woo Hyung; Suh, Bo Yang; Kwun, Koing Bo

Abstract

PURPOSE & METHOD: To evaluate clinical pattern and operative outcome of the ischemic lower extremity, 142 patients who were admitted to Yeungnam University Hospital between January 1996 to December 1998 were analyzed.
RESULTS
The patients were 125 males and 17 females ranging from 21 to 88 years of age. The mean age was 59, with the highest incidence among people in their 60s, followed by those in their 70s and then in their 50s. The causes of arterial occlusive disease were artherosclerotic obliterans (ASO) in 87 cases (61.2%), thromboangitis obliterans (TAO) in 44 cases (30.9%), thromboembolism in 10 cases and superficial femoral aneurysm in 1 case. Associated diseases in ASO were hypertension in 37 cases (42.5%), diabetes mellitus in 17 cases (30.9%), cardiac disease in 24 cases (27.5%) and cerebrovascular disease in 7 cases (8.0%). History of smoking was noted in 77.4% of the cases. The major arterial occlusive site of ASO were femoral artery in 36 cases (41.3%), aortoiliac artery in 26 cases (29.8%), iliofemoral artery in 9 cases (10.3%), popliteal artery in 5 cases (5.7%), tibial artery in 6 cases (6.8%) and multi-level occlusion in 5 cases (5.7%). The major arterial occlusive site of TAO were tibial artery in 35 cases (79.5%), pedal artery in 8 cases (18.1%) and popliteal artery in 1 case. According to the Fontaine classification of clinical symptoms, the distribution was as follows: Grade 0 0 case, Grade I 48 cases (33.8%), Grade II 46 cases (32.3%) and Grade III 48 cases (33.8%). The operative procedures of arterial occlusive disease were bypass graft operation in 72 cases, thromboembolectomy in 12 cases, endarterectomy in 2 cases and percutaneous transluminal angioplasty (PTA) was performed in 9 cases. Arterial bypass operation with autogenous or artificial prosthesis were done in 72 cases, which included aortobifemoral or aortobipopliteal bypass in 12 cases, iliofemoral bypass in 5 cases, femoropopliteal bypass in 26 cases, femorotibial bypass in 5 cases, popliteotibial bypass in 8 cases. axillobifemoral bypass in 4 cases and femorofemoral bypass in 12 cases. In over 90% of the operative cases, the early outcome was good with 3+ to 2+ rating according to Rutherford criteria. Mortality for 114 cases was 2.6% (3 cases), including 2 resulting from associated cardiac condition and 1 resulting from ARDS.
CONCLUSION
Strategies for successful revascularization and long term patency may be made by consideration of the extent of diseases, associated diseases, clinical symptoms and status of distal perfusion.