Abstract
Background: Acute lower limb ischaemia (ALI) is a life and limb threatening vascular emergency. Acute compartment syndrome (ACS) may develop upon revascularization. The risk of fasciotomy was hypothesized to be decreased in women due to their lower calf muscle mass. The main aim was to evaluate risk factors for fasciotomy after revascularization for ALI.Methods: This is a retrospective observational study of patients undergoing revascularization for ALI between 2001 and 2018. Factors associated with outcome at 1 year in univariable analysis (p < 0.1) were chosen for multi-variable analysis and expressed in Odds Ratios (OR) with 95% confidence intervals (CI).Results: The median age for women (n = 394) was 75 years and men (n = 449) was 70 years (p < 0.001). The frequency of fasciotomy was 10.0% (84/843). The median in-hospital stay was 28 vs. 6 days for patients undergoing fasciotomy and not, respectively (p < 0.001). In adjusted analysis, renal insufficiency (OR 1.77, 95% CI 1.04–3.01), motor deficit (OR 4.40, 95% CI 2.45–7.92), popliteal artery aneurysm thromboembolism (OR 2.26, 95% CI 1.06–4.80), and open vascular surgery (OR 3.43, 95% CI 1.97–5.98) were associated with an increased risk of fasciotomy. Female patients (OR 0.49, 95% CI 0.28–0.84) and anemia (OR 0.52, 95% CI 0.28–0.84) had a lower risk. The major amputation/mortality rate at 1-year was 27.7%; fasciotomy (OR 1.94, 95% CI 1.11–3.40), anemia (OR 1.84, 95% CI 1.24–2.73) and female gender (OR 1.44, 95% CI 1.00–2.08) were independently associated with an increased risk.Conclusions: Female patients had lower rates of fasciotomies, but subsequent higher risk of major amputation/mortality, which may be attributed to inferior results of revascularization. Lower muscle mass and underdiagnosis of ACS could also explain the lower frequency of fasciotomy for female patients. Further studies are needed to better understand gender differences in presentation of ALI, revascularization results and diagnosis of ACS.
Highlights
Acute lower limb ischaemia (ALI) is caused by sudden onset of hypoperfusion of one or both lower extremities, most commonly a result of an arterial thrombosis or embolism
The main aim of this study was to evaluate risk factors for fasciotomy, and a secondary aim was to investigate risk factors associated with combined major amputation/mortality at 1 year, after reperfusion due to ALI
ALI secondary to popliteal artery aneurysm (PAA) was caused by thrombotic occlusion within the aneurysm in 71.9% (n = 46) and embolism to the calf arteries from the non-occlusive thrombosis within the aneurysm in 28.1% (n = 18)
Summary
Acute lower limb ischaemia (ALI) is caused by sudden onset of hypoperfusion of one or both lower extremities, most commonly a result of an arterial thrombosis or embolism. ALI can cause muscle necrosis and irreversible nerve damage, limb gangrene and death. A complication after a revascularization procedure for ALI is acute compartment syndrome (ACS), where the ischaemic muscle cells are further damaged upon reperfusion [2]. Compartment syndrome following reperfusion for ALI can be anticipated, whereby the vascular surgeon completes the primary revascularization procedure by a prophylactic fasciotomy before reperfusion injury to the muscles has occurred. The hypothesis of the present study was that female gender due to their, in general, lower calf muscle mass [5] was a protective factor toward ACS and fasciotomy. Acute compartment syndrome (ACS) may develop upon revascularization. The risk of fasciotomy was hypothesized to be decreased in women due to their lower calf muscle mass. The main aim was to evaluate risk factors for fasciotomy after revascularization for ALI
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