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Risk factors associated with acute lower extremity ischemia after coronary revascularization
Debra Kohlman-Trigoboff1, Enrique Gongora, Jon Stanford
1Washington Hospital Center, Section of Vascular Surgery, Washington, DC 20010, USA.
Insights
Acute lower extremity ischemia (ALEI) following coronary revascularization is a serious complication. Identifying patients with arterial occlusive disease (AOD) is crucial to prevent limb-threatening events.
Area of Science:
- Vascular Surgery
- Cardiology
- Interventional Cardiology
Background:
- Acute lower extremity ischemia (ALEI) is a known complication after coronary revascularization.
- Patients undergoing coronary revascularization often have coexisting lower extremity arterial occlusive disease (AOD).
- The lower extremity vasculature may be overlooked until severe ischemia occurs.
Purpose of the Study:
- To identify risk factors for ALEI in patients undergoing coronary revascularization.
- To discuss methods for identifying at-risk patients before profound ischemia develops.
Main Methods:
- Retrospective review of 35,000 coronary revascularization procedures.
- Identification of 55 patients who developed ALEI post-cardiac procedure.
Main Results:
- ALEI occurred in 55 patients after coronary revascularization.
- Identified risk factors include femoral artery instrumentation, prior coronary revascularization, hemodynamic instability, and known AOD.
Conclusions:
- ALEI is a significant complication of coronary revascularization.
- Awareness of risk factors and proactive vascular assessment are essential for prevention.
Abstract:
Acute lower extremity ischemia (ALEI) is a recognized complication of coronary revascularization that can lead to emergent lower extremity revascularization, amputation, and death. Patients with correctable coronary artery disease have a high incidence of lower extremity arterial occlusive disease (AOD). But, despite the known high correlation between AOD and coronary artery disease, the status of the lower extremity vasculature in patients undergoing coronary revascularization may be overlooked until the lower extremity becomes profoundly ischemic. Data from a retrospective review of 35,000 coronary revascularization procedures identified 55 patients who developed ALEI, subsequent to their cardiac procedures. Risk factors for ALEI included femoral artery instrumentation, previous coronary revascularization, hemodynamic instability, and documented AOD. Means of identifying patients at risk for ALEI are discussed.