Spectrum of Acute Limb Ischemia and Management – A Single-center Study in Northern India

Abstract

Background: Acute limb ischemia (ALI) can be defined as sudden deterioration in limb perfusion, often producing new or worsening symptomatology and usually threatening limb viability. The incidence of ALI is approximately 1.5 cases per 10,000 persons per year. Objective: The main objective of the study is to assess the spectrum of ALI and effective management options in a tertiary care center. Methodology: This was a retrospective and prospective observational study. All patients admitted in tertiary care center with ALI were included in this study. The medical records of patients admitted since last three years were collected retrospectively and the data of patients with ALI getting admitted during next one year was collected simultaneously. Patients who were included prospectively were followed for at least one month. Results: In the study period, we received 136 patients with 138 ALI (ALI presenting with 14 days = 95, ACLI = 17, ALI with delayed presentation = 26). Average age of patients was 47.4 years. 21 to 40 years age group made the largest cohort of 56 patients. 10.79% of the lower limb ischemia were female (15 out of 136). Among these categories, the outcomes depend upon the time of presentation (earlier presentation has the better outcomes in terms of limb salvage). The delayed presentation of ALI has poorer outcome of amputation whereas mortality rates are higher in ALI presenting early. Patency in ALI is better due to embolus. Outcome of ALI due to embolus are best followed by acute thromboembolic occlusion without pre-existing CLI. The worst outcomes in amputation are for ACLI when they present late. Etiology wise Cardio embolic group comprised as the commonest cause; High Altitude Thrombosis also is very significant in our setting. Class II B ischemia which is most surgically amenable, and the amputation rate is 20%. Conclusion: In our study, outcome of various modalities of management of ALI has been evaluated. Our study provided data which could be accessed to define the outcome and most amenable to any useful intervention affecting outcome in patients of limb ischemia. Revascularization in ALI is aimed not only to prevent amputation but also to limit the level of amputation which is a forgotten aspect of salvage procedure in lower extremity.