Acute limb ischemia due to arterial embolism or thrombosis: influence of limb ischemia versus pre-existing cardiac disease on postoperative mortality rate.

Fatal outcome is common after arterial thromboembolectomy. Initial conservative treatment has been suggested to reduce the mortality rate, but the indications for such treatment are poorly defined. This analysis of 201 patients with acute arterial embolism or thrombosis demonstrates that advanced age, recent myocardial infarction, and proximal occlusions are associated with a high mortality rate after arterial thromboembolectomy. Operations performed 13-24 hours after the onset of ischemia, arteriosclerosis in the occluded artery and poor distal backbleeding after completion of thromboembolectomy were also associated with an increased mortality rate, whereas surprisingly the presence of pre-existing cardiac disease, recent myocardial infarction excluded, was not. The present findings suggest that the prognosis quoad vitam after arterial thromboembolectomy is influenced by limb ischemia itself and possibly also by the revascularization procedure. It is suggested that the severity of limb ischemia and an assessment of cardiac function should determine the initial treatment: conservative treatment, or early attempts at revascularization.