CLINICAL DISTINCTION OF ACUTE AND ACUTE ON CHRONIC LEG ISCHEMIA

The importance of the distinction between acute embolic ischaemia and acute on chronic ischaemia caused by a thrombus superimposed on an art eriosclerotic stenoses has been emphasized during the recent years, as the differentiation should affect the choice of surgical treatment. A retrospective attempt was made to differentiate between acute ischaem ia (AI = embolism) and acute on chronic ischaemia (AOCI = thrombosis) of the leg by categorizing the patients according to the clinical char acteristics they presented. The material consisted of 194 ischaemic lo wer limbs of 189 patients who underwent a balloon-catheter thromboembo lectomy because of sudden arterial occlusion. The retrospective diagno sis of AI was made in 94 (48 %) and AOCI in 69 (36 %) cases. The preop erative assessment could not be done in 43 (22 %) patients by surgeon working at the emergency room. The retrospective distinction was impos sible in 31 (16 %) patients. The preoperative diagnosis was in better agreement with the retrospective category when AI, as opposed to AOCI, was the aetiology of occlusion (70 % vs 46 %). The results of the pre sent study emphasize the difficulties of clinical assessment. These fi ndings suggest a routine angiography as an evaluative tool in the plan ning of optimal management especially as most of the patients today ca n be treated simultaneously by thrombolysis.