Abstract
Background: Acute lower limb ischemia with a motor deficit (Rutherford IIb) needs urgent revascularization to avoid major amputation and mortality. It is unclear whether immediate revascularization without performing CT angiography (CTA) prior to revascularization in Rutherford IIb acute lower limb ischemia (ALI) is associated with better outcomes.Methods: Retrospective observational study of Rutherford IIb ALI patients treated between 2006 and 2018. A propensity score adjusted analysis was performed to compare outcomes after the performance of CTA examination or not.Results: Among 681 patients, 260 had Rutherford IIb ALI. CTA prior to revascularization was performed in 131 (50.4%) and increased (p < 0.001) throughout the study period. Open vascular and endovascular surgery was first performed in 147 (56.5%) and 113 (43.5%) patients, respectively. The proportion of endovascular treatment increased while the open vascular surgery decreased during the study period (p = 0.031). In the propensity score adjusted analysis, the performance of CTA was associated with decreased risk of combined major amputation /mortality (odds ratio 0.52, 95% confidence interval 0.27–0.99; p = 0.046) at 1 year.Conclusion: Performance of CTA was associated with a higher amputation-free survival in revascularized patients with Rutherford IIb ALI. CTA seem to provide guidance in selecting the most appropriate candidates for revascularization and choice of technique.
Highlights
Important technical advancements have been made, acute lower limb ischemia (ALI) remains associated with high rates of amputation, mortality [1], and reperfusion injuries [2]
A more modern approach has begun to take form resulting in more clinicians choosing to manage patients with Rutherford IIb ALI, like Rutherford I and IIa ALI, by performing imaging, often computed tomography angiography (CTA), prior to intervention
The main objective of this study was to evaluate if immediate revascularization without performing CTA prior to revascularization in Rutherford IIb ALI is associated with better outcomes
Summary
Important technical advancements have been made, acute lower limb ischemia (ALI) remains associated with high rates of amputation, mortality [1], and reperfusion injuries [2]. Emergent revascularization is especially important in Rutherford IIb [3] ALI patients since motor deficit at presentation is associated with poor prognosis. Acute lower limb ischemia with a motor deficit (Rutherford IIb) needs urgent revascularization to avoid major amputation and mortality. It is unclear whether immediate revascularization without performing CT angiography (CTA) prior to revascularization in Rutherford IIb acute lower limb ischemia (ALI) is associated with better outcomes
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