ACUTE LEG ISCHEMIA - A CASE FOR THE JUNIOR SURGEON

Objective: To evaluate the change in the type of acute leg ischaemia a nd the outcome of its treatment in relation to the experience of the s urgeon responsible for the treatment. Design: A 12-year (1980-1991) re trospective study based on hospital records and population vital stati stics. Setting: A defined population of 165,000 served by one central hospital (CH) and two district hospitals (DH). Subjects: 282 intervent ions performed for acute leg ischaemia. Main outcome measures: Type of leg ischaemia, reintervention, amputation and survival rates in relat ion to the type of ischaemia, treatment and surgical expertise. Result s: Thrombotic acute ischaemia increased by 91 % and graft occlusions b y 130 % while embolisation numbers remained unchanged during the perio d. With junior, general and vascular surgeons operating on acute ischa emia, the respective 30-day amputation rates were 25 %, 18 % and 9 %. Postoperative mortality was 29 %, 33 % and 8 % respectively. The recon struction rate for the vascular surgeon was 67 % with 33 % thrombectom ies, while the figures for junior surgeons were 2 % and 98 % and for s enior surgeons 6 % and 94 %. Conclusion: Mortality and amputation rate s in acute ischaemia are high. By judicious use of different treatment modalities, as judged by vascular surgical experience, better limb sa lvage rates may be achieved especially in patients with acute on chron ic ischaemia.