Arterial Embolism of the Lower Extremity

Jung, Suk In; Choi, Sang Yong; Whang, Cheung Wung

Abstract

Despite the fact that the balloon catheter has greatly improved the technique of embolectomy, limb loss and mortality rates still remain high in some patients. The natural clinical course of a peripheral arterial embolism depends upon the location of the occlusion, the completeness of the luminal obliteration, the extent of secondary thrombosis, and the degree of spontaneous restoration of the collateral circulation. Surgeons should get accustomed to managing this disease appropriately. We wanted to know how to analyze the factors of amputation and operative mortality in those patients. For this study, we selected 46 cases of arterial embolectomies due to arterial embolisms of the lower extremity which were performed at Korea University Hospital between 1990 to 1996. Among the 46 cases, 39 cases were male and 9 cases were female. The etiologies of arterial embolism were 28 due to atrial fibrillation, 9 due to valvular heart disease. In the interval to therapy, 1) there were 7 cases severe ischemia and 3 cases amputations in a group for whom the embolectomy was done within 48 hours in 34 cases. 2) there were 5 cases of severe ischemia and 2 cases of amputations in a group for whom embolectomy was done after 48 hours. Popliteal artery occlusions were associated with severe ischemia and high amputation rates of 42.9%, and 28.6%, respectively. There were 6 cases of collateral circulation in the preoperative angiogram, one amputation was performed. Collateral circulation was not shown in 32 cases, but amputation was performed in 4 cases. In conclusion, this study shows that the prognosis of arterial embolism of the lower extremity can be improved by early detection, an early embolectomy, and the involvement of a qualified vascular surgeon. For a late arterial embolectomy, i.e., one beyond 48 hours after onset, indications are that even if the operation is performed one or several days beyond the accepted operation time, complete or adequate restoration of arterial flow to the limb may be achieved.