Clinical Study of Acute Arterial Occlusion of Lower Extremities.
- Author:
Soon Cheon LEE
1
;
Moon O BAE
;
Sang Yong CHUNG
;
Soojinna CHOI
;
Shin Kon KIM
Author Information
1. Department of Surgery, Chonnam University Medical School, Kwangju, Korea.
- Publication Type:Original Article
- Keywords:
Acute arterial occlusion;
Fogarty thromboembolectomy;
Angioscopy
- MeSH:
Amputation;
Angiography;
Angioscopy;
Atherosclerosis;
Atrial Fibrillation;
Catheters;
Early Diagnosis;
Embolism;
Female;
Heart;
Humans;
Incidence;
Lower Extremity*;
Male;
Myocardial Ischemia;
Phenobarbital;
Shock, Cardiogenic;
Thrombosis
- From:Journal of the Korean Society for Vascular Surgery
2000;16(1):85-90
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: The major source of acute peripheral arterial occlusion has been embolization from the heart. However overall improvement in medical care have increased life spans, resulting in significant increase in the incidence of systemic atherosclerosis and thrombotic occlusion of peripheral vessels. Recently, occlusion from in situ thrombosis has surpassed occlusion from embolization as the major cause of acute arterial occlusion. The introduction of the balloon catheter technique in 1963 dramatically simplified the technical aspect of surgical therapy for acute arterial occlusion and it became the main modality of the therapy. Recently, numerous reports have documented increased identification of intraluminal defects after arterial surgery using angioscopy as compared with those using intraoperative arteriography, and for this reason, the use of intraluminal angioscopy has grown in popularity. METHODS: We analyzed clinical characteristics and treatment results in patients with acute arterial occlusion. The variables studied include location, etiology, time interval from occurrence of occlusion to performance of thromboembolectomy. RESULTS: There were 41 men and 4 women and most prevalent age group was in 7th decades. The causes of acute arterial occlusion were embolism in 21 cases (46.7%), thrombosis in 24 cases (53.3%). The primary source of embolism was heart in 20 cases as a result of ischemic heart disease (n=11, 52.4%) and atrial fibrillation (n=9, 42.9%). Two patients in embolic group died of cardiogenic shock and were in shorter duration group (<24 hours). Iliac arterial occlusion group was associated with highest amputation rate (23.1%). Amputation rates were 12.5% for thromboembolectomy performed within 24 hours of onset of symptoms, and 17.4% when performed after 48 hours. We used angioscopic technique in limited cases of 5 patients to detect residual thrombus, intimal flap and other intraluminal defects. CONCLUSION: To improve outcome, early diagnosis and early treatment are essential. Direct visualization of the arterial lumen with angioscopy during thromboembolectomy procedure would provide a more reliable method of assessing luminal morphologic characteristics than angiography alone.
