Patterns, Clinical Management, and Short-Term Outcomes of Acute Limb Ischemia (ALI) Seen In In-Hospital and...

Area of Science:

• Vascular Surgery
• Critical Care Medicine
• Emergency Medicine

Background:

• Acute limb ischemia (ALI) is a critical vascular condition with substantial morbidity and mortality.
• Existing research predominantly addresses community-onset ALI, with limited data on in-hospital onset cases.
• In-hospital ALI may present unique challenges in management and prognosis due to patient comorbidities.

Purpose of the Study:

• To compare the clinical characteristics and outcomes of in-hospital onset ALI versus out-of-hospital onset ALI.
• To identify factors influencing mortality and amputation rates in ALI patients.
• To evaluate the impact of onset location on ALI management strategies.

Main Methods:

• Retrospective review of patients undergoing emergency surgical thrombectomy for ALI.
• Classification of ALI into in-hospital and out-of-hospital onset groups.
• Exclusion of ALI cases related to vascular access, iatrogenic causes, or bypass graft occlusion.
• Analysis of outcomes including 30-day mortality, in-hospital mortality, and major amputation.

Main Results:

• Six patients (24%) had in-hospital onset ALI, while 19 (76%) had out-of-hospital onset.
• The in-hospital group exhibited a higher prevalence of active cancer and infection.
• Thirty-day mortality was significantly higher in the in-hospital onset group (50% vs. 0%).
• Limb-related outcomes, including amputation, were comparable between groups, with no major amputations performed.

Conclusions:

• In-hospital onset ALI is associated with substantially higher early mortality compared to out-of-hospital onset ALI.
• Prognosis in in-hospital ALI is largely dictated by severe systemic illness rather than the limb ischemia itself.
• Despite higher mortality, in-hospital ALI is not uniformly fatal, necessitating individualized treatment based on the patient's overall clinical status.