ACUTE LOWER-EXTREMITY ISCHEMIA AFTER CARDIAC-SURGERY

A retrospective review during a 5-year period (1987 to 1992) was condu cted of all patients manifesting leg ischemia after major cardiac surg ery. There were 7,620 procedures performed, and 65 (0.85%) patients (m ean age: 65 years) were identified with acute ischemia. Diagnosis was made by physical examination, during which a cool pulseless extremity without pedal Doppler signals was noted in 63 of 65 patients (97%). An intra-aortic balloon pump (IABP) was inserted in 56 patients (86%). T reatment regimens included medical management (17), IABP removal (4), IABP removal and thromboembolectomy (24), thromboembolectomy and endar terectomy with patch angioplasty (10), femoral-femoral bypass (17), ot her bypasses (6), fasciotomy (10), and amputation (16). Morbidity was 92% and mortality was 46%. Mortality was 11% in those patients develop ing ischemia without an IABP. Acute leg ischemia after cardiac surgery is predictive of high morbidity and mortality. This reflects the comp romised cardiac status and multi-system disease. Treatment alternative s are based on the overall clinical status, degree of arterial insuffi ciency, and distribution of pre-existing peripheral vascular disease. However, ultimate limb salvage had no influence on overall patient sur vival in our study.