WHEN IS URGENT REVASCULARIZATION UNNECESSARY FOR ACUTE LOWER-LIMB ISCHEMIA

Objectives: To predict the risk of gangrene by the use of simple clini cal parameters available on admission. Design: Retrospective compariso n using logistic regression and chi(2) analyses of prospectively regis tered data from two patients series. Methods: One group of patients wi th acute lower limb ischaemia, (n = 61) was managed by selective initi al non-operative treatment (NO) in a university hospital. The other gr oup (n = 173) contained patients managed by early revascularisation in a multicentre (MC) study from 20 university, county and district hosp itals. Gangrene and death within one month were recorded. Results: 57% of patients in the NO group were initially managed by intravenous hep ar in followed by surgery when necessary. Impaired motor function and skin cyanosis in the ischaemic limb predicted gangrene. Patients witho ut this combination were low risk (LR) patients and constituted 62% (N O) and 67% (MC). Non-operatively managed LR patients did not develop g angrene, whereas 14% of those undergoing early revascularisation in ti re two series did (p < 0.05). Conclusions: The results suggest that pa tients without motor disturbance and cyanosis are at low risk of gangr ene and may benefit from initial non-operative treatment, irrespective of the presumed aetiology.