Abstract
SUMMARY
Objective: Acute peripheral arterial embolism is the third most common
emergency case in the vascular surgery following aneurysm ruptures and arterial
injuries. The aim of this study is to determine the effects of the time between the onset of complaints and surgery on outcomes and mortality in cases of acute peripheral arterial embolism.
Material and Method: We retrospectively examined the surgical outcomes in
the early period of 726 patients who underwent a total of 870 operations for acute
peripheral arterial embolism at our clinic between May 1993 and February 2012. The mean age of the patients was 65.2 ± 13.9 years.There were 419 (58 %) men, 307 (42 %) women patients The mean time between the onset of symptoms and the time of admission to the hospital was 23.8 ± 6 hours.The patients divided into two groups according to admission time before or after 24 hours.
Results: Among the patients; 595 (81 %) were admitted less than 24 hours and
131 (19 %) were admitted more than 24 hours (p< 0.001). The rate of motion functional
loss was determined in the 86 %of the patients with late admission time and in the 51
%of the patients with early admission time (p< 0.001). The rate of succesfull
revascularization was 89 %in the patients who were admitted within 24 hours and 60
%in the patients who were admitted more than 24 hours (p<0.001). The rate of
amputation was 1 %and mortality rate was 5 %in the patients who were admitted
within 24 hours whereas these rates were found in the patients who were admitted more
than 24 hours as 27 %and 28 %, respectively. There was the significantly difference
between the groups (p<0.001). Re-embolectomy required in the 64 %of the patients
with late admission time and the 10 %of the patients with early admission time
(p<0.001). Faciotomy was performed in the 5 %of the patients who were admitted
within 24 hours and in the 42 %of the patients who were admitted more than 24 hours
(p<0.001). Among the two groups, the necessary of additional surgical interventions
was found higher by the rate 6 %versus 36 %in the patients who were admitted more
than 24 hours (p<0.001).
Conclusion: Duration of ischemia is an important factor affecting surgical
results in the patients with acute peripheral arterial embolism. Peripheral embolism is a
serious clinical situation which required early diagnosis and interventions for preventing
hig mortality and morbidity.
Keywords
References
- Referans1. Braithwaite B.D, Davies B, Birch P.A, Heather B.P, and Earnshaw J.J. Management of acute leg ischemia in the elderly. British Journal of Surgery, 1988; 85: 217-220.
- Referans2. Haimovici H, Ascer E, Hollier L.H. Arterial embolism of the extremities and technique of embolectomy. In: H. Haimovici ed. Vasculer Surgery. Cambridge Masachusets Blackwell Science, Fourth edition, 1996; 423-444.
- Referans3. Abbott W, Maloney R, McCabe C, Lee C and Wirthlin L. Arterial embolism: A 44 year perspective, Am J Surg, 1982; 143(4): 460-464.
- Referans4. Haimovici H: Muscular, renal, and metabolic complications of acute arterial occlusions: Myonefropatic-metabolic syndrome. Surgery, 1979: 85; 461-468.
- Referans5. Patel N, Sacks D, Patel RI, et al. SCVIR reporting standards for the treatment of acute limb ischemia with use of transluminal removal of arterial thrombus. J Vasc Interv Radiol, 2001; 12: 559–570.
- Referans6. Elliot J.P,HagemanJ. H, Szilagyi D.E, Ramakrishnan V, Bravo J.J, Smith R.F. Arterial embolization: Problems of source, multiplicty, recurrence and delayed treatment. Surgery, 1980; 88: 833-845.
- Referans7. Martin P, King RB, Stephenson CB. Late embolectomy. Surg, 1969: 56; 882.
- Referans8. Mutirangura P, Ruangsetakit C, Wongwanit C, Sermsathanasawadi N, Chinsakchai K. Acute arterial embolism of the lower extremities: Impact of 24-Hour Duration on the Outcome of Management. J Med Assoc Thai, 2008; 91: 1360-1366.
- Referans9. Fecteau S, Darling RC, Roddy SP. Arterial thromboembolism. İn: Rutherford RB ed;Vascular Surgery. Philadelphia, Elsevier, 2005: 971-986.
- Referans10. Güler A, Şahin MA, Karabacak K, Küçükaslan N, Yokuşoğlu M, Tatar H. Alt ekstremite gecikmiş tromboembolik arteriyel tıkanmalarda aynı seansta embolektomi ve kapalı fasiyotomi beraberliği. Anadolu Kardiyol Derg, 2009; 9:407-410.
- Referans11. Johnson JA, Cogbill TH, Strutt PJ. Late results after femoral arter embolectomy.Surg, 1975:103; 289-293.
- Referans12. Keçeligil HT, Küsdül M, Gökgözoğlu G, Saraç A, Kolbakır F, Akar H ve ark. Akut periferik arteryel tıkanıklıklar: 179 olgunun sunumu. Türk Göğüs Kalp Damar CerDerg, 1999; 7:319-23.
- Referans13. Karapolat S, Dağ Ö, Abanoz M, Aslan M. Arterial Embolectomy: A retrospective evaluation of 730 cases over 20 years. Surg Today, 2006; 36: 416-419
- Referans14. Berqvist D, Troeng T, Elfstrom J,et al. Auditing Surgical Outcome: Ten years with The SwedishVascular Registry—Swedvasc. The Steering Committee of Swedvasc. Eur J Vasc Endovasc Surg, 1998; 164(suppl 581): 3-8.
- Referans15. Burma O, Uysal A, Akar I, Yücedağ E, Rahman A. Akut periferik arteryel tıkanıklıklarda tromboembolektomi sonuçlarını etkileyen faktörler. Türk Göğüs Kalp Damar Cer Derg, 2005; 13(4): 369-373.
- Referans16. Erentuğ V, Mansuroğlu D, Bozbuğa N, et al. Akut arteriyel tıkanıklarda cerrahi tedavi. Turkish J Thorac Cardiovasc Surg, 2003; 11: 236-239.
- Referans17. Topal AE, Eren NM, Çelik Y. Management of non-traumatic acute limb ischemia and predictors of outcome in 270 thrombembolectomy cases. Int Angiol, 2010:29(5);21-27.
- Referans18. Gülmen Ş. Akut arter tıkanıklıklarında mortaliteye eşlik eden faktörler. S.D.Ü Tıp Fak Derg, 2008: 15(2); 12-16.
- Referans19. Kempe, K., Starr, B., Stafford, J. M., Islam, A., Mooney, A., Lagergren, E., Corriere, M. A., & Edwards, M. S. (2014). Results of surgical management of acute thromboembolic lower extremity ischemia. Journal of vascular surgery, 60(3), 702–707. https://doi.org/10.1016/j.jvs.2014.03.273
- Referans20. Iyem H, Eren NM. Should embolectomy be performed in late acute lower extremity arterial occlusions. Vascular Health and Risk Management, 2009: 5; 621-626.
- Referans21. Cambrıa R, Ridge B, Brewster D. Delayed presentation and treatment of popliteal artery embolism. Ann Surg, 1991:214;50-55.
- Referans22. Shifrin EG, Anner H, Eid A, Romanof H. Practice and theory of delayed embolectomy. A 22 yer perspective. J Cardiovasc Surg, 1986: 5;553-556.
- Referans23. Taviloğlu K, Günay K, Asoğlu O, Dilege Ş, Kurtoğlu M. 10 yıllık periferik arteryel tıkanıklık olgularımızın analizi. Damar Cerrahisi Dergisi, 1995: 4; 17-21
Abstract
Amaç: Akut periferik arteriyel emboli, anevrizma rüptürü ve arteriyel
yaralanmalardan sonra damar cerrahisinin üçüncü sıklıkta görülen acil durumudur.
Bu çalışmanın amacı akut periferik arteriyel emboli vakalarında şikayetlerin başlaması ile cerrahi yapılması arasında geçen sürenin sonuçlara ve mortalite üzerine olan etkilerini
değerlendirmektir.
Materyal ve Metod: Mayıs 1993 ile Şubat 2012 tarihleri arasında
kliniğimize müracaat eden
ve akut periferik arteriyel emboli tanısı konan 726 hastaya uygulanan 870 cerrahi
müdahalenin erken dönem sonuçları retrospektif olarak değerlendirildi. Hastaların
ortalama yaşı 65,2 ± 13,9 idi. 419 hasta (%58) erkek, 307 hasta (%42) kadın idi. Şikayetlerinin başlaması ile hastaneye başvuru zamanı arasında geçen süre ortalama 23,8 ± 6 saat idi. Hastalar başvuru zamanına göre 24 saatden önce ve sonra olmak üzere 2 gruba ayrıldı.
Bulgular: 595 hastada (%81) başvuru zamanı 24 saatden önce, 131 hastada
(%19) 24 saatden sonra idi (p< 0.001). Geç başvuran hasta grubunda, başvuru anında
ekstremitede motor fonksiyon kaybı %86, erken başvuran hasta grubunda %51
oranında tespit edildi (p<0.001). 24 saat içinde başvuran hasta grubunda%89, 24
saatden sonra başvuran hasta grubunda %60 oranında başarılı revaskülarizasyon
sağlandı (p< 0.001). 24 saat içinde başvuran hasta grubunda amputasyon oranı %1,
mortalite oranı %5 iken 24 saatden sonra başvuran hasta grubunda bu oranlar sırasıyla
%27, %28 bulundu ve anlamlı fark tespit edildi (p< 0.001). Geç başvuran hastaların
%64 ‘ne, erken başvuran hastaların %10’ nuna re-embolektomi gerekti (p< 0.001).
Erken başvuran hastaların %5’ ne, geç başvuran hastaların %42’sine fasiyotomi yapıldı
(p< 0.001). İki grup arasında, ek işlem ihtiyacı %6 ya %36 oranıyla 24 saatden sonra
başvuran hasta grubunda anlamlı yüksek bulundu (p< 0.001).
Sonuç: Akut periferik arteriyel embolide iskemi süresi, cerrahi sonuçları
etkileyen önemli bir faktördür. Yüksek mortalite ve morbiditeyi önlemek için erken tanı
ve tedavi gerektiren ciddi bir klinik tablodur.
References
- Referans1. Braithwaite B.D, Davies B, Birch P.A, Heather B.P, and Earnshaw J.J. Management of acute leg ischemia in the elderly. British Journal of Surgery, 1988; 85: 217-220.
- Referans2. Haimovici H, Ascer E, Hollier L.H. Arterial embolism of the extremities and technique of embolectomy. In: H. Haimovici ed. Vasculer Surgery. Cambridge Masachusets Blackwell Science, Fourth edition, 1996; 423-444.
- Referans3. Abbott W, Maloney R, McCabe C, Lee C and Wirthlin L. Arterial embolism: A 44 year perspective, Am J Surg, 1982; 143(4): 460-464.
- Referans4. Haimovici H: Muscular, renal, and metabolic complications of acute arterial occlusions: Myonefropatic-metabolic syndrome. Surgery, 1979: 85; 461-468.
- Referans5. Patel N, Sacks D, Patel RI, et al. SCVIR reporting standards for the treatment of acute limb ischemia with use of transluminal removal of arterial thrombus. J Vasc Interv Radiol, 2001; 12: 559–570.
- Referans6. Elliot J.P,HagemanJ. H, Szilagyi D.E, Ramakrishnan V, Bravo J.J, Smith R.F. Arterial embolization: Problems of source, multiplicty, recurrence and delayed treatment. Surgery, 1980; 88: 833-845.
- Referans7. Martin P, King RB, Stephenson CB. Late embolectomy. Surg, 1969: 56; 882.
- Referans8. Mutirangura P, Ruangsetakit C, Wongwanit C, Sermsathanasawadi N, Chinsakchai K. Acute arterial embolism of the lower extremities: Impact of 24-Hour Duration on the Outcome of Management. J Med Assoc Thai, 2008; 91: 1360-1366.
- Referans9. Fecteau S, Darling RC, Roddy SP. Arterial thromboembolism. İn: Rutherford RB ed;Vascular Surgery. Philadelphia, Elsevier, 2005: 971-986.
- Referans10. Güler A, Şahin MA, Karabacak K, Küçükaslan N, Yokuşoğlu M, Tatar H. Alt ekstremite gecikmiş tromboembolik arteriyel tıkanmalarda aynı seansta embolektomi ve kapalı fasiyotomi beraberliği. Anadolu Kardiyol Derg, 2009; 9:407-410.
- Referans11. Johnson JA, Cogbill TH, Strutt PJ. Late results after femoral arter embolectomy.Surg, 1975:103; 289-293.
- Referans12. Keçeligil HT, Küsdül M, Gökgözoğlu G, Saraç A, Kolbakır F, Akar H ve ark. Akut periferik arteryel tıkanıklıklar: 179 olgunun sunumu. Türk Göğüs Kalp Damar CerDerg, 1999; 7:319-23.
- Referans13. Karapolat S, Dağ Ö, Abanoz M, Aslan M. Arterial Embolectomy: A retrospective evaluation of 730 cases over 20 years. Surg Today, 2006; 36: 416-419
- Referans14. Berqvist D, Troeng T, Elfstrom J,et al. Auditing Surgical Outcome: Ten years with The SwedishVascular Registry—Swedvasc. The Steering Committee of Swedvasc. Eur J Vasc Endovasc Surg, 1998; 164(suppl 581): 3-8.
- Referans15. Burma O, Uysal A, Akar I, Yücedağ E, Rahman A. Akut periferik arteryel tıkanıklıklarda tromboembolektomi sonuçlarını etkileyen faktörler. Türk Göğüs Kalp Damar Cer Derg, 2005; 13(4): 369-373.
- Referans16. Erentuğ V, Mansuroğlu D, Bozbuğa N, et al. Akut arteriyel tıkanıklarda cerrahi tedavi. Turkish J Thorac Cardiovasc Surg, 2003; 11: 236-239.
- Referans17. Topal AE, Eren NM, Çelik Y. Management of non-traumatic acute limb ischemia and predictors of outcome in 270 thrombembolectomy cases. Int Angiol, 2010:29(5);21-27.
- Referans18. Gülmen Ş. Akut arter tıkanıklıklarında mortaliteye eşlik eden faktörler. S.D.Ü Tıp Fak Derg, 2008: 15(2); 12-16.
- Referans19. Kempe, K., Starr, B., Stafford, J. M., Islam, A., Mooney, A., Lagergren, E., Corriere, M. A., & Edwards, M. S. (2014). Results of surgical management of acute thromboembolic lower extremity ischemia. Journal of vascular surgery, 60(3), 702–707. https://doi.org/10.1016/j.jvs.2014.03.273
- Referans20. Iyem H, Eren NM. Should embolectomy be performed in late acute lower extremity arterial occlusions. Vascular Health and Risk Management, 2009: 5; 621-626.
- Referans21. Cambrıa R, Ridge B, Brewster D. Delayed presentation and treatment of popliteal artery embolism. Ann Surg, 1991:214;50-55.
- Referans22. Shifrin EG, Anner H, Eid A, Romanof H. Practice and theory of delayed embolectomy. A 22 yer perspective. J Cardiovasc Surg, 1986: 5;553-556.
- Referans23. Taviloğlu K, Günay K, Asoğlu O, Dilege Ş, Kurtoğlu M. 10 yıllık periferik arteryel tıkanıklık olgularımızın analizi. Damar Cerrahisi Dergisi, 1995: 4; 17-21
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Surgery |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | April 30, 2023 |
| Submission Date | January 23, 2023 |
| Published in Issue | Year 2023 Volume: 2 Issue: 1 |
