Contemporary Management of Acute Lower Limb Ischemia: Determinants of Treatment Choice

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Peripheral Artery Disease

Background:

• The management of acute lower limb ischemia (ALI) involves a choice between surgical and endovascular interventions.
• The optimal treatment strategy for ALI remains a subject of ongoing debate.
• Endovascular techniques are increasingly utilized, necessitating a clear understanding of treatment selection factors.

Purpose of the Study:

• To identify key factors influencing the choice between surgical and endovascular treatment for ALI.
• To analyze patient characteristics and outcomes associated with different treatment modalities.
• To inform clinical decision-making and potentially refine existing ALI classification systems.

Main Methods:

• Retrospective analysis of 307 patients with ALI, including 209 with thrombosis.
• Evaluation of patient demographics, clinical presentation, and procedural choices.
• Statistical analysis to determine factors associated with treatment selection and patient outcomes.

Main Results:

• Surgery was performed in 52.4% of patients.
• Surgical intervention was favored in cases of embolic ALI, severe ischemia, and concurrent cancer.
• Tibial artery involvement was associated with a lower likelihood of surgical treatment.
• Complication and amputation rates were similar between groups.
• Endovascular treatment led to higher reintervention rates.
• Six-month mortality was significantly higher in the surgically treated group.

Conclusions:

• Ischemia severity, presence of embolus, concurrent cancer, and lesion location are critical determinants for ALI treatment selection.
• The Rutherford classification may require modification to better guide decisions in severe ALI cases.
• Further research is needed to optimize treatment pathways for ALI patients.