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Factors affecting limb salvage and mortality in patients undergoing femoral embolectomy
R Vohra1, H Zahrani, D P Lieberman
1Peripheral Vascular Unit, Glasgow Royal Infirmary, UK.
Insights
This study analyzed 131 acute femoral arterial occlusions, finding that delayed thromboembolectomy significantly increased mortality risk. Early fasciotomy was crucial for preventing neurological deficits in compartment syndrome cases.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Emergency Medicine
Background:
- Acute femoral arterial occlusion is a critical vascular emergency.
- Cardiac embolism is a common cause of lower limb ischemia.
- Prompt diagnosis and treatment are essential for limb salvage and patient survival.
Purpose of the Study:
- To evaluate the management and outcomes of acute femoral arterial occlusions.
- To identify risk factors for mortality and limb loss.
- To assess the effectiveness of thromboembolectomy and fasciotomy.
Main Methods:
- Retrospective analysis of 131 cases of acute femoral arterial occlusion over 7 years.
- Review of patient demographics, etiology of occlusion, treatment modalities, and outcomes.
- Statistical analysis to identify significant risk factors for mortality and morbidity.
Main Results:
- 82% of occlusions were due to cardiac emboli; 96% of patients underwent thromboembolectomy.
- Overall mortality was 26%, with an 88% limb salvage rate among survivors.
- Delayed embolectomy (>24 hours) was a statistically significant risk factor for mortality.
Conclusions:
- Thromboembolectomy is the primary treatment for acute femoral arterial occlusion.
- Timely intervention is critical to improve outcomes and reduce mortality.
- Early fasciotomy can prevent neurological deficits in cases of compartment syndrome.
Abstract:
The management and outcome of 131 acute femoral arterial occlusions in 126 patients over a period of 7 years is presented. The emboli were of cardiac origin in 82% of cases; 96% of the patients were treated with thromboembolectomy. The overall mortality rate was 26% with a limb salvage rate of 88% amongst the survivors. There was an increased risk of mortality in patients having both atrial fibrillation and myocardial infarction, saddle emboli and those having delayed embolectomy after 24 h. Only the latter was found to be statistically significant. One-third of the patients who died had a failed embolectomy. An early fasciotomy helped in preventing permanent neurological deficit in patients with compartment syndrome.