ARTERIAL EMBOLI OF THE LOWER-LIMBS - ANALYSIS OF RISK-FACTORS FOR MORTALITY AND AMPUTATION

To evaluate risk factors for mortality and amputation after arterial e mbolism of the lower limbs, we reviewed the records of 397 patients (2 01 men [mean age 69 +/- 14 years] and 196 women [mean age 79 +/- 12 ye ars]) who were enrolled in a prospective study. The degree of ischemia was rated as follows: grade I in 26% of patients, grade II in 46%, an d grade III in 27%. Among patients with complete obstruction, the embo li were located above the inguinal ligament in 213 limbs (46%), in the superficial or popliteal artery in 196 (43%), and at the infrapoplite al level in four (3%). The emboli were bilateral in 59 cases (15%). In 11% of patients the emboli also involved either an upper limb or a vi sceral or cerebral artery. The origin of the embolus was the heart in 55% of patients, an artery in 12%, and was unknown in the remaining ca ses. Two hundred two patients (50%) had arterial fibrillation, 33 (8%) had cardiac conduction abnormalities, 186 (47%) had ischemic heart di sease, 55 (14%) had valvular heart disease, and 43 (11%) had cardiac i nsufficiency. The in-hospital mortality rate was 15% (n = 60) and majo r amputations or severe ischemic sequelae were observed in 23% (n = 91 ). Logistic regression analysis revealed four independent preoperative factors associated with a significantly higher risk of death: associa ted visceral emboli with a relative risk (RR) of 6.7 (p <0.001), inval idism with an RR of 4.3 (p <0.001), cardiac insufficiency with an RR o f 2.4 (p = 0.001), and creatinemia >180 ml/L with an RR of 2.1 (p = 0. 01). The variables associated with an increased risk of amputation wer e invalidism (p = 0.001), severity of ischemia (p = 0.001), infrapopli teal location of the embolus (p = 0.001), delay of more than 12 hours before treatment of severe ischemia was initiated (p = 0.01), failure to restore arterial patency (p = 0.001), and postoperative cardiac com plications (p = 0.01).