Acute limb ischemia registry, the forgotten emergency

Abstract

Abstract Background Although acute limb ischemia (ALI) is a leading cause of death and lower limb amputation, knowledge about its epidemiology, presentation, and treatment is limited. Aim The purpose of this study is to describe patient characteristics, diagnostic approaches taken, modes of presentation, and clinical developments in patients with ALI. Methods We prospectively included all ALI outpatients between 2016 and 2022. Patients who had ischemia due to trauma, iatrogenic causes, or those who developed it while in the hospital were excluded. We provide descriptive analysis for our registry, and performed a uni and multivariable regression model in order to identify clinical factors associated with the composite primary endpoint of intrahospital death and limb amputation. Results We included 89 consecutive patients with ALI. Table 1 describes the baseline characteristics. The median time from clinical presentation to first medical contact was 24 hours (IQR 4-72 hours). Time between clinical consultation and diagnosis was 1 hours (1.1–7 hours), and time between diagnosis and revascularization was 12 hours (4–36 hours). Although patients with a threatened limb sought treatment sooner than those without (12 hours vs 72 hours, p = 0.001), they had a higher rate of events. Peripheral thromboembolism was the main cause of ALI and the only etiology associated with death or amputation. Patients considered candidates for reperfusion therapy comprised 92% of the cohort, while 3 patients were considered candidates for direct amputation and 2 patients were considered candidates for anticoagulation due to the comorbidities they presented. Thirteen patients (21%) died or suffered limb amputations (three suprapatellar, two infrapatellar, and one in the forefoot). One third of the patients suffered a complication during hospitalization. Acute renal failure was the most frequent complication (27%). In a univariable regression analysis, age, embolic origin, higher levels of lactacidemia, and threatened limb were associated with the composite event of death and limb amputation, whereas in a multivariable regression model, serum lactic acid and have the vitality of the member threatened were independently associated with an increased odds of death or amputation (Tabla 2). Conclusions Acute limb ischemia is associated with an increased risk of intrahospital death and limb amputation. Serum lactacidemia and limb threatened at presentation were independently associated with an increased risk of clinical events. Risk of events is associated with the limb clinical condition and not with the delay in revascularization. Even those patients who do not die or are amputated have high morbidity and need for prolonged hospitalization. Increased awareness of the disease are critical for improving survival and limb preservation.