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Peripheral arterial embolism. A follow-up of 130 consecutive patients submitted to embolectomy
Abstract:
A series of 130 consecutive patients operated on for peripheral arterial embolism in 152 extremities and the longterm results of surgery are presented. The source of embolism was identifiable in 82 percent of the cases, atrial fibrillation being the source in 37 percent and myocardial infarction in 24 percent. Microscopy of the embolus permitted the diagnosis bronchogenic carcinoma in five patients. Echocardiography resulted in surgical correction in one younger patient with left atrial myxoma. Fourteen percent of the patients died after embolectomy. The initial limb salvage rate was 77 percent, and had fallen to 39 percent at the time of follow-up. The cause of this fall in salvage rate was not amputations, but excessive high mortality in the patient group compared to the normal population. The cumulative survival rate was thus 69, 39 and 21 percent, one, five, and 10 years after operation. Death was primarily due to the patients' underlying cardiovascular disease.
Insights
Peripheral arterial embolism surgery has a high initial limb salvage rate but poor long-term survival due to underlying cardiovascular disease mortality. Identifying the embolism source is crucial for patient outcomes.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Oncology
Background:
- Peripheral arterial embolism (PAE) poses significant risks to limb viability and patient survival.
- Understanding the sources and long-term outcomes of PAE is critical for effective management.
Purpose of the Study:
- To present the long-term surgical results for patients treated for peripheral arterial embolism.
- To identify common sources of embolism and their impact on outcomes.
Main Methods:
- Retrospective analysis of 130 consecutive patients undergoing surgery for PAE across 152 extremities.
- Evaluation of embolism sources, including echocardiography and embolus microscopy.
- Assessment of long-term limb salvage and patient survival rates.
Main Results:
- Embolism source identified in 82% of cases; atrial fibrillation (37%) and myocardial infarction (24%) were most common.
- Bronchogenic carcinoma diagnosed via embolus microscopy in 5 patients; left atrial myxoma in 1.
- Initial limb salvage was 77%, decreasing to 39% at follow-up.
- Cumulative survival rates were 69% (1 year), 39% (5 years), and 21% (10 years).
- High mortality, primarily from cardiovascular disease, significantly impacted long-term survival.
Conclusions:
- Surgical embolectomy for PAE offers limited long-term limb salvage due to high patient mortality.
- Underlying cardiovascular disease is the primary driver of mortality in this patient cohort.
- Comprehensive evaluation for embolism sources, including less common causes like malignancy, is essential.