NONTRAUMATIC LOWER-EXTREMITY ACUTE ARTERIAL ISCHEMIA

BACKGROUND: The outcome of arterial bypass reconstruction in the setti ng of-acute arterial ischemia has not been well defined. METHODS: This retrospective review consists of 71 consecutive patients (54 with nat ive arterial thrombosis, 17 with graft thrombosis) who underwent an ur gent/emergent arterial bypass reconstruction for acute arterial ischem ia with threatened limb viability. RESULTS: The 30-day mortality and m ajor amputation rates were 9.9% and 7.1%, respectively Death, limb los s, or both, were associated with a paralytic limb (P = 0.001) and cong estive heart failure (P = 0.03). Overall, 45 of 71 (63%) patients were discharged with limb salvage and ambulatory function. Cumulative graf t patency was 77% and 65% at 1 and 2 years, respectively, and closely approximated the 1- and 2-year limb-salvage rates of 76% and 63%, resp ectively. CONCLUSIONS: Arterial bypass reconstructions appear warrante d in acute arterial ischemia, in that a majority of patients retain a functional viable limb. Late graft thrombotic complications limit long -term benefit. Am J Surg. 1998;176:147-152. (C) 1998 by Excerpta Medic a, Inc.