Treatment of Acute Limb Arterial Embolism and Influencing Factors of Its Prognosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MA Yukui , ZHAO Jichun , HUANG Bin , HU Zhi

Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Acute arterial embolism; Limb; Treatment; Prognosis

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Objective　 To present and summarize the data concerning the treatment and prognosis of acute limb arterial embolism in West China Hospital.
Methods 　Forty three patients with 52 limbs of acute arterial embolism were treated in West China Hospital from January 2003 to March 2006. There were 15 males and 28 females, aging from 26 years to 77 years 〔(58.88±13.90) years〕. The diagnosis was based on clinical manifestations and results of color Doppler sonography or DSA. The follow-up ranged from 1 month to 39 months. The following factors, which might influence the prognosis, were analysed through multiple linear regression of SPSS 10.0: age, sex, uper limb or lower limb, location of embolus, ischemic time, clinical categories of acute limb ischemia, history of smoking,
atherosclerosis and other combined diseases, pervious history of acute limb arterial embolism, operative or nonoperative treatment, and postoperative complications.
Results 　 Clinical categories of acute limb ischemia include: Ⅰ (n=0),Ⅱa (n=16), Ⅱb (n=29), Ⅲ (n=7). The ischemic time varied from 3 h to 2 weeks. The sources of embolus: heart (n=39), vessle (n=7), iatrogenic origin (n=1), unidentidied origin (n=5). The therapies included embolectomy (n=38), catheter-directed thrombolysis (n=2) and medical treatment (n=12). The following postoperative complications occured: compartment syndrome (n=12), respiratory failure (n=3), alkalolsis (n=3), acute renal failure (n=2), wound infection (n=2) and pulmonary infection (n=1). Two patients died of cerebral infarction in hospital and one patient died of heart failure 3 months after discharge. Thirty-eight patients with 45 diseased limbs were followed up. The results were excellent in 13 limbs, good in 15 ones, fair in 8 ones and poor in 9 ones. The statistically significant influencing factors of prognosis include ischemic time, clinical categories of acute limb ischemia and history of smoking (P＜0.05).
Conclusion 　 The operation of embolectomy is the main treatment of acute limb arterial embolism. In selected patients, catheter-directed thrombolysis and medical treatment could be used to alleviate the limb ischemia. The treatment against the etiological factors should not be ignored. The prognosis of this disease could be influenced by ischemic time, clinical categories of acute limb ischemia and history of smoking.

Citation： MA Yukui,ZHAO Jichun,HUANG Bin,HU Zhi. Treatment of Acute Limb Arterial Embolism and Influencing Factors of Its Prognosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2007, 14(6): 689-693. doi: Copy

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10.	Hooi JD, Kester AD, Stoffers HE, et al. Incidence of and risk factors for asymptomatic peripheral arterial occlusive disease: a longitudinal study [Ｊ]. Am J Epidemiol, 2001; 153(7)∶666.
11.	Hooi JD, Stoffers HE, Knottnerus JA, et al. The prognosis of non-critical limb ischaemia: a systematic review of population-based evidence [Ｊ]. Br J Gen Pract, 1999; 49(438)∶49.
12.	Yoshitomi Y, Kojima S, Umemoto T, et al. Serum hepatocyte growth factor in patients with peripheral arterial occlusive disease [Ｊ]. J Clin Endocrinol Metab, 1999; 84(7)∶2425.
13.	Zacharski LR, Chow BK, Howes PS, et al. Reduction of iron stores and cardiovascular outcomes in patients with peripheral arterial disease: a randomized controlled trial [Ｊ]. JAMA, 2007; 297(6)∶603.
14.	Banta MR, Ma F, Bravata DM, et al. Incidence of and factors associated with achieving target lipid levels in patients with peripheral arterial disease [Ｊ]. J Gen Intern Med, 2006; 21(7)∶711.
15.	Aboyans V, Criqui MH, Denenberg JO, et al. Risk factors for progression of peripheral arterial disease in large and small vessels [Ｊ]. Circulation, 2006; 113(22)∶2623.
16.	吴庆华，吴敏掌，陈忠, 等. 反复肢体动脉栓35例的治疗经验 [Ｊ]. 中华普通外科杂志， 2002； 17(1)∶12.
17.	李雪松，戈小虎，赛力木, 等. 急性肢体动脉栓塞手术治疗（附47例报告） [Ｊ]. 中国普外基础与临床杂志, 2004; 11（2）∶118.
18.	Carlson GA, Hoballah JJ, Sharp WJ. Surgical thrombectomy: current role in thromboembolic occlusions [Ｊ]. Tech Vasc Interv Radiol, 2003; 6(1)∶14.
19.	Ouriel K, Shortell CK, DeWeese JA, et al. A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia [Ｊ]. J Vasc Surg, 1994; 19(6)∶1021.
20.	Ouriel K, Veith FJ. Acute lower limb ischemia: determinants of outcome [Ｊ]. Surgery, 1998; 124(2)∶336.

1. 　Billig DM, Hallman GL, Cooley DA. Arterial embolism. Surgical treatment and results [Ｊ]. Arch Surg， 1967; 95(1)∶1.
2. 　Rutherford RB, Baker JD, Ernst C, et al. Recommended sta-ndards for reports dealing with lower extremity ischemia: revised version [Ｊ]. J Vasc Surg， 1997; 26(3)∶517.
3. 　汪忠镐，李震. 我国血管外科的现状和发展 [Ｊ]. 中国普外基础与临床杂志, 2006; 13（6）∶625.
4. 　杜筠，孙立中. 急性肢体动脉栓塞的外科治疗及预后因素 [Ｊ]. 心肺血管杂志, 2004； 23（2）∶95.
5. 　金毕，赖传善，田敏, 等. 急性肢体动脉栓塞93例诊治分析 [Ｊ]. 临床外科杂志, 2001； 9（2）∶76.
6. 　Robert B. Rutherford Eds. Rutherford vascular surgery [M]. 1st ed. Beijing： People’s Medical Publishing House, 2002∶822-835.
7. 　张昌明，张福先，金英姬, 等. 急性肢体动脉栓塞61例 [Ｊ]. 铁道医学， 2001； 29（1）∶42.
8. 　任为，时德，赵渝. 急性周围动脉栓塞预后的多因素分析 [Ｊ]. 重庆医科大学学报， 2004； 29（1）∶58.
9. 　郭曙光，陈翠菊，周兴立, 等. 影响急性肢体动脉栓塞手术治疗效果的因素分析 [Ｊ]. 临床外科杂志， 2002； 10（4）∶214.
10. 　Hooi JD, Kester AD, Stoffers HE, et al. Incidence of and risk factors for asymptomatic peripheral arterial occlusive disease: a longitudinal study [Ｊ]. Am J Epidemiol, 2001; 153(7)∶666.
11. 　Hooi JD, Stoffers HE, Knottnerus JA, et al. The prognosis of non-critical limb ischaemia: a systematic review of population-based evidence [Ｊ]. Br J Gen Pract, 1999; 49(438)∶49.
12. 　Yoshitomi Y, Kojima S, Umemoto T, et al. Serum hepatocyte growth factor in patients with peripheral arterial occlusive disease [Ｊ]. J Clin Endocrinol Metab, 1999; 84(7)∶2425.
13. 　Zacharski LR, Chow BK, Howes PS, et al. Reduction of iron stores and cardiovascular outcomes in patients with peripheral arterial disease: a randomized controlled trial [Ｊ]. JAMA, 2007; 297(6)∶603.
14. 　Banta MR, Ma F, Bravata DM, et al. Incidence of and factors associated with achieving target lipid levels in patients with peripheral arterial disease [Ｊ]. J Gen Intern Med, 2006; 21(7)∶711.
15. 　Aboyans V, Criqui MH, Denenberg JO, et al. Risk factors for progression of peripheral arterial disease in large and small vessels [Ｊ]. Circulation, 2006; 113(22)∶2623.
16. 　吴庆华，吴敏掌，陈忠, 等. 反复肢体动脉栓35例的治疗经验 [Ｊ]. 中华普通外科杂志， 2002； 17(1)∶12.
17. 　李雪松，戈小虎，赛力木, 等. 急性肢体动脉栓塞手术治疗（附47例报告） [Ｊ]. 中国普外基础与临床杂志, 2004; 11（2）∶118.
18. 　Carlson GA, Hoballah JJ, Sharp WJ. Surgical thrombectomy: current role in thromboembolic occlusions [Ｊ]. Tech Vasc Interv Radiol, 2003; 6(1)∶14.
19. 　Ouriel K, Shortell CK, DeWeese JA, et al. A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia [Ｊ]. J Vasc Surg, 1994; 19(6)∶1021.
20. 　Ouriel K, Veith FJ. Acute lower limb ischemia: determinants of outcome [Ｊ]. Surgery, 1998; 124(2)∶336.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Treatment of Acute Limb Arterial Embolism and Influencing Factors of Its Prognosis

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