The surgical management of acute limb ischaemia due to native vessel occlusion

Objectives: data from the STILE study have indicated that for patients with subacute limb ischaemia due to native vessel occlusion, surgery is both mo re effective and durable than thrombolysis. The purpose of this study was t o evaluate the outcome of an aggressive surgical approach in patients prese nting with acute limb-threatening ischaemia. Design: details of patients presenting with salvageable acute limb ischaemi a due to native artery occlusion over a 6-year period in a University hospi tal vascular unit setting were obtained from the vascular audit and the out come of the surgical management of these patients was analysed. Results: one hundred and seventy-four consecutive patients underwent survey for acute native vessel limb ischaemia (76% lower, 24% upper limb). Fogart y thrombectomy or embolectomy was initially performed in 153 (89%) patients . Of these, 37 (24%) immediately underwent a further procedure: 28 (18%) ha d on-table thrombolysis and 14 (9%) underwent vascular reconstruction. Twen ty-six patients (15%) underwent further limb salvage surgery within 30 days . Life table analysis demonstrated a limb salvage rate of 88% and 76% at 30 days and 2 years, respectively. Patient survival was 75% and 48% at the sa me time intervals. Conclusions: these results demonstrate that a role for aggressive surgical intervention still exists, resulting in high limb salvage rates.