Abstract
The role of endovascular procedures in the treatment of acute lower limb ischemia (ALI) is expanding. For treatment, the choice between surgical or endovascular is still debated. The aim of this study was to identify factors that determine the selection of treatment. This study included 307 ALI patients (209 with thrombosis). Patient details, factors affecting the procedure choice, and outcomes were analyzed. The majority of patients were operated on (52.4%). Surgery was more frequent in embolic patients with embolus (odds ratio (OR) 33.85; 95% confidence interval (CI) 6.22–184.19, p < 0.0001), severe ischemia (OR 1.79; 95% CI 1.2–2.66, p = 0.0041), and active cancer (OR 4.99; 95% CI 1.26–19.72, p = 0.02). Tibial arteries involvement was negatively related to surgery (OR 0.25; 95% CI 0.06–0.95, p = 0.04). The complications and amputation rates were comparable. Reinterventions were more common in the endovascular group (19 (20.2%) vs. 17 (8.9%), p = 0.007). The six-month mortality was higher in the operated patients (12.6% vs. 3.2%, respectively, p = 0.001). The determinants of the treatment path are ischemia severity, concurrent cancer, embolus, and peripheral lesion location. Modification of the Rutherford acute lower limb ischemia classification is required to improve the decision-making in patients with profound ischemia.
Highlights
Acute lower limb ischemia (ALI) is a sudden deficit of limb perfusion, threating extremity viability
Short duration, Rutherford III, embolus, iliac location of the lesion, coronary artery disease (CAD), recent myocardial infarction (MI), congestive heart failure (CHF), atrial fibrillation (FA), and active cancer were more common in the surgical treatment arm
Longer ischemia duration, Rutherford I and IIa, peripheral, and multilevel lesion location were observed in the endovascular cohort (Table 2)
Summary
Acute lower limb ischemia (ALI) is a sudden deficit of limb perfusion, threating extremity viability. Until the 1980s, surgical intervention was the only available option for the ALI treatment. Since the introduction of endovascular management in peripheral arteries disease treatment, it has become an essential tool in ALI patients [2,3,4]. No strict recommendations exist for using either surgical or endovascular approaches, endoluminal treatment is gaining increased acceptance [5]. Large randomized trials and meta-analyses indicated no difference regarding treatment results, and individualized decisions were recommended [6,7,8,9]. In these studies, no attention was paid to the heterogeneity of ALI patients. The primary aim of this study was to identify the factors that affect the treatment selection to facilitate further studies in this area
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