Prognostic factors for amputation or death in patients submitted to vascular surgery for acute limb ischemia

Clebes Fagundes¹, Flávio Danni Fuchs², Almondi Fagundes¹, Ronaldo A Poerschke¹, Maurício Z Vacaro¹

¹Divisions of Vascular Surgery, Hospital São Vicente de Paulo, Faculdade de Medicina da Universidade de Passo Fundo; ²Cardiology, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

Objective: To investigate the risk profile of patients with thrombosis and emboli, and prognostic factors for death or amputation in patients presenting with acute limb ischemia in a tertiary care regional hospital in Brazil.

Methods: A prospectively planned cohort study was carried out in which 83 patients with acute limb ischemia, secondary to thrombosis, or embolism, classified in stages II and III of severity were evaluated. Univariate analysis and logistic regression models were used to explore the relationship between anthropometric and demographic characteristics, comorbidities, cardiovascular risk factors, duration of occlusion, and type of surgery with the incidence of amputation or death, which were evaluated in 30 days and 1 year thereafter.

Results: Male gender, smoking, and comorbidities were more frequent among patients with thrombosis, and atrial fibrillation was more common among patients with embolism. Occlusion longer than 24 hours (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.1–7.6) and a trend for diabetes (RR 2.6, 95% CI 0.9–7.5) were the characteristics associated with death or amputation in the multivariate analysis, which occurred in 15 (18.1%) and 24 (28.9%) of the participants, respectively. Reperfusion injury was a risk factor for death but not for amputation (OR 16.9, 95% CI 1.1–232.9) after adjustment for age, duration of occlusion, and diabetes.

Conclusions: Traditional and avoidable risk factors explain the occurrence of thrombosis and embolism in our region. Access to medical care is the most important and modifiable prognostic factor for death or amputation.

Keywords: acute limb ischemia, embolism, thrombosis, prognostic factors