Lower limb ischemia

646 MEDICINA (2003) Vol. 39, No.7 - http://medicina.kmu.lt
The surgical treatment of the lower limb acute ischemia
Aleksandras Antuševas, Nerijus Aleksynas
Department of Vascular Surgery, Kaunas University of Medicine Hospital, Lithuania
Key words: embolism, acute thrombosis, operations, the early results of surgical treatment,
total death-rate.
Summary. Objective. To analyze the surgical treatment strategy of lower limb acute
ischemia and its results in the Department of Vascular Surgery of Kaunas University of
Medicine Hospital in the period from 1999 to 2001.
Material and methods. While collecting the data retrospectively there has been deter-
mined, that due to the acute ischemia of the limbs there have been operated 244 patients
(12.2% of all treated arterial patients). Because of the lower limb acute ischemia there
have been operated 142 (7.1%) patients. All embolism and thrombosis have been approved
with the operation findings. The comparison of quantitative values was done according to
the Student parameter.
Results. The acute ischemia in the leg has been caused by: embolism – for 76 (53.5%)
patients, acute thrombosis – for 66 (46.5%). Heart diseases have been ascertained in em-
bolism group for 22.4% of patients, in acute thrombosis group – for 6.1%. The localities of
embolism – the popliteal artery for 44.7% and femoral artery for 32.9%, acute thrombosis
– in the femoral artery for 37.9% and iliac artery for 22.7%. Men experience the acute
thrombosis more often (3.5:1), p<0.0001, and women – embolism (2.5:1), p<0.0001. Em-
bolism has been treated with embolectomy, and acute thrombosis with thrombectomy,
thrombendarterectomy and the bypass operations. There have been made 4.9% of great
amputations, rescued 96.1% of lower limbs with the features of acute ischemia. Total death
rate – 4.2%.
Conclusions. The acute ischemia in the leg because of embolism was for 76 patients, the
acute thrombosis – for 66 patients. Lower limbs embolism of arteries is more common for
women, p<0.0001, acute thrombosis for men, p<0.0001. The death rate is higher in women
group with acute ischemia than men, (p=0.1198) and in men group with acute ischemia in
the lower limb there are made more great amputations (p=0.04250).
Correspondence to N. Aleksynas, Department of Vascular Surgery, Kaunas University of Medicine Hospital,
Eivenių2, 3007Kaunas, Lithuania. E-mail: nalex@takas.lt
Introduction
In the whole population the acute ischemia of limbs
and organs happens in 14 cases per 100000 inhabit-
ants from 10 to 16% in the angiosurgery (1, 2). The
acute ischemia in the limb is caused by an acute arte-
rial impassibility in the main arteries, because of the
basic reasons - embolism, acute thrombosis and the
damage of blood vessels (Table 1). Acute arterial
thrombosis is divided into several main groups 1) acute
arteriosclerotic thrombosis, 2) acute jaterogenetic
thrombosis, and 3) acute thrombosis of tiny arteries.
The largest group involves the acute arteriosclerotic
thrombosis, which is mainly caused by arteriosclero-
sis. In this case the acute thrombosis can develop as
primary thrombosis, after previous asymptomatic ar-
teriosclerotic lamella has ulcerated, or as the second-
ary of thrombosis, when an acute arterial impassibility
develops because of previously existing stenotic or
occlusive arteriosclerotic artery changes (3). Arterial
embolism is very often related with heart ischemia and
mitral valves. Thrombi occur in the ear of the left au-
ricle most often after that they align from the inner
heart or the aorta wall and “travel” to the distal arte-
rial system parts. Such thrombi are called embolus.
Most often they stick in the divarication of the joint
femoral artery or in the trident of the popliteal artery
(back of the knee) and disturb the flow of blood to the
further branches. Thecollateral circulation of theblood
will be bad in the blocked up artery as the occlusive
disease most often does not exist and the limb tissues
suffer from an acute ischemia which has such domi-
nating symptoms as pain, thepaleness of theskin, cold-

647
ness, the absence of the pulsation of arteries, pares-
thesia (4, 5). The symptoms caused by embolism are
much more acute and the initial stage of thrombosis is
rather hidden (4). The development speed of the pri-
mary thrombosis of acute ischemia features practi-
cally does not differ from embolism because the col-
lateral circulation of the blood will not be developed
and in the secondary stage of acute thrombosis fea-
tures will develop slower as the collateral circulation
of the blood will already exist because of the partial
permeability in the main artery. The acute ischemia is
stimulated by arteritis, simple vasospasm additionally
(the second stage of ergotism) (6), the deepening of
heart failure in the field of chronic occlusive disease
(7), the thrombosis of deep veins in the early period
(8), and acute compressive neuropathy (9).
In the transacted work acute ischemia – pain, skin
paleness, coldness, paresthesia, the changes of the
pulsation of arteries is not more than 36 hours. Such
proportion of time and symptomatic most often arises
because of acute embolism and primary acute throm-
bosis. In the case of the secondary acute thrombosis
symptoms won‘t be so vivid, their deepening will arise
during a longer time period (3), but they will be indi-
cated during the above mentioned hours.
The main treatment in the acute limb ischemia is
operation. In the case of embolism – embolectomy,
in the acute case of thrombosis – thrombectomy,
thromboendarterectomy, bypass operations, more
rarely – catheter thrombolysis, percutaneous
transluminal angioplasty, subintimal recanalization. In
the IIIrd
stage when neuromuscular limb system dies
the initial small and great amputations are made. In
1963, when Fogarty catheters and very aggressive
operative treatment were started to be used as well,
there was a hope to achieve better results, however
that didn‘t happen. The early death rate of patients
reached 10-30% at that time, amputations were made
in the cases of 20-30% (Table 2). Bad results were
influenced by insufficient examination of patients
before operation, non-optimal tactics of treatment,
insufficient preparation before operation and the
treatment after operation, often incomplete restora-
tion of circulation of the blood in the limb (4).Above-
mentioned problems are being solved successfully in
KUMH (Kaunas University of Medicine Hospital)
recently, that‘s why there have been achieved good
treatment results.
The goal of this work is to define the frequency,
localization, division according to agegroups and sexes
of acute ischemia embolism and thrombosis, early re-
sults, evaluate the variety of operations and compare
the achieved results with literary data.
Material and methods
During 1999–2001 in KUMH in the Department
ofAngiosurgery there were made 2000 operations and
244 (12.2%) of them were made because of the acute
main arteries impassibility. Theacuteischemia of lower
limb was ascertained for 142 (7.1%) patients.
In KUMH there is being used a classification of
acutelimb ischemia which reflects patient’s complaints,
objective findings and prognosis (6) that has been of-
fered by Society for Vascular Surgery/International
Society for Cardiovascular Surgery.
Class I - Limb viable - No persisting pain, no motor or
sensory deficits, Doppler distal arterial signals clearly
audible.
Class IIa - Limb marginally threatened -Additionally,
numbness and paresthesias or limited (digital) sensory
loss and no audible Doppler signals.
Class IIb - Limb immediately threatened - In addition,
persisting ischemic pain, greater sensory loss, and any
motors deficit.
1 table. Etiology of acute limb ischemia
(Hobson RW, 1992) (19)
Embolus
Atrial fibrillation
Valvular heart disease
Endocarditis
Myocardial infarction (with mural thrombus)
Aortic and peripheral arterial aneurysms
Ulcerated atherosclerotic plaque with
intraplaque hemorrhage
Paradoxical embolus
Atrial myxoma
Cardiomyopathy
Thrombosis
Atherosclerotic occlusive disease
Aortic and peripheral arterial aneurysms
Intraplaque hemorrhage with arterial sthenosis
and occlusion
Hypercoagulable states (C ar S protein defi-
ciencies)
Entrapment syndromes
Stasis/low-flow states
Drugs of abuse
Trauma
Penetrating
Blunt
Interventional vascular procedures
MEDICINA (2003) Vol. 39, No.7 - http://medicina.kmu.lt

648
Study Year Number Limb salvage Mortality rate
of patients (%) (%)
R. M. Green et al. 1975 149 86.5 22
D. W. Hight et al. 1976 124 78 29.8
W. F. Blaisdel et al. 1978 54 74 7.5
T. J. Fogarty 1978 360 94 15
F. R. Plecha 1978 63 97 24
B. Santiant et al. 1978 122 81 10.6
J. P. Elliott Jr et al. 1980 – 85 3
J. E. Lorentzen et al. 1980 130 77 14
L. W. Silvers et al. 1980 106 86.5 21.7
J. A. Caruana et al. 1981 61 75 11.4
J. Kendrick et al. 1981 90 71 18
W. M. Abbott et al. 1982 313 86 25
H. M. Sheiner et al. 1982 134 87 20
W. Andrew Dale 1983 65 73 11
F. Pellegrino et al. 1987 98 73 14.5
G. Illuminati et al. 1993 119 72 25
J. Dormandy et al. 1994 – 80 15
P. Kuukasjarvi et al. 1997 509 84 13
D. F. Neuzil et al. 1998 216 92.6 9.7
KUMH 1999–2001 142 96.1 4.2
Table 2. Treatment results of acute lower limb ischemia
Fig. 1. Angiogram. The embolism of femoral
artery
The squashing of contrastive material above the
blocked place
Fig. 2. Angiogram. The thrombosis of femoral
artery
The break of contrastive material in the shape of diagonal
cloth line shape. There are seen collateral arteries

649
Class III - Irreversible changes in limb - Profound
anesthesia and paralysis:
early - limb with these latter findings soon after
the onset of ischemia should be managed like those
in Class IIb, for differentiation is impossible.
late - Limb with muscle rigor, marbling of the skin,
and/or without detectable venous flow, even with com-
pressive maneuvers, can be considered to have major
irreversible changes.
For the definition of diagnosis there were evalu-
ated clinics, ultrasound tests of the circulation of the
blood, angiographic pictures (Fig.1, 2) and operation
findings. In the cases of embolism there was made
embolectomy and in the cases of acute thrombosis –
thrombectomy, bypass operations and thromboendar-
terectomy. There were analyzed treatment results af-
ter two weeks after the operation, the division of pa-
tients according the age and the compare of data with
the data, which is given by other authors.
Results
In the angiosurgery department of KUMH there
were examined 142 patients with an acute ischemia
of lower limb not more than 36 hours from the start of
the clinic.
The acute ischemia in the lower limb was diag-
nosed for 74 men (52 %) whose average age was
68.3±12 years, and for 68 women (48%) whose aver-
age age was76.2±8years.
An acute ischemia was caused by embolism for
76 (53.5%) patients and acute thrombosis was diag-
nosed for 66 (46.5%) patients. The acute embolism in
women group was for 78%, in men group for 31%.
The acute thrombosis in men group was for 69%, in
women - for 22%. In the emboli group heart disease
was defined for 22.4%, and in the group of thrombo-
sis for 6.1% patients. The embolism was in the femo-
ral artery for 32.9 %, popliteal artery for 4.7%, tibialis
artery for 7% patients. Thrombosis damaged the femo-
ral artery for 37.9%, iliac artery for 22.7%, popliteal
artery for 22.2% patients (Fig. 4.).
In the case of acute thrombosis there were made
17 (25.8%) shunting, and 2 (3%) thromboendarterec-
tomy operations. Thelower limb embolismwas treated
only with embolectomy while using Fogarty catheters.
For 142 operated patients because of acute ischemia
in the lower limb there were made 7 (4.9%) great
amputations totally and there were saved 96.1% of
limbs. When the reason of acute ischemia was embo-
lism, there were made 2 (2.6%) great amputations and
when there acute thrombosis there made – 5 great
amputations (7.6%).
The total death rate in the group of 142 patients
with acute leg ischemia was 4.2% (6 patients), the
death rate in the group of 76 patients with emboli was
Aorta Iliac Femoral Popliteal Tibial
(%) artery (%) artery (%) artery (%) artery (%)
Embolism
J. Horton et al. 17 21 46 10 4
W. A. Dale 7.1 7.1 50 28.6 7.2
D. Raithel 16 17.7 52 14.3 –
A. Enjalbert et al. 19.6 29.6 50.8 – –
Average incidence 14.9 18.8 51.9 17.6 5.6
KUMH – 15.8 32.9 44.7 7
Acute thrombosis
J. Horton et al. 10 14 55 18 1
W. A. Dale – 25 32.1 28.6 14.3
D. Raithel 10 35.9 42.9 11.2 –
A. Enjalbert et al. 2.5 33.6 60.6 3.3 –
Average incidence 7.5 27.1 47.7 15.3 7.6
KUMH – 22.7 37.9 24.2 2
Table 3. Relative incidence of arterial occliusion by location in embolism and acute thrombosis
46.5 %
53.5 %
embolism thrombosis
Fig.3. Relative incidence of arterial embolism
and acute thrombosis
Studija

650
5.3% (4 patients) and in the group of 66 patients with
acute thrombosis - 3% (2 patients).
Results and discussion
In the studies, which were obtained by 7 foreign
authors and in which there were examined 1576 pa-
tients in order to ascertain acute limb ischemia rea-
sons there was found that more frequent reason is
embolism (892 – 56.6%) than thrombosis (684 –
43.4%) (3). This data corresponds theresults achieved
by us (Fig.3.). Moreover, the results obtained by us
while examining the frequency of heart diseases in
the emboli group assert the data of other authors in
which heart diseases in the group of embolism are
defined more frequently because of much improved
diagnostic possibilities (10-13).
The emboli most often stick in the ramification of
branches of main arteries (4) that is asserted by the
results obtained by us. In the Table 3 there are com-
pared localizations of embolism and acute thrombosis
in the lower limb, which were ascertained by us and
other authors.
The reason of the acute ischemia in the lower limb
for men (51-77.3%) more often than for women (15-
22.7%) was acute thrombosis, p<0.0001. The acute
ischemia in the lower limb for women (53-69.7%)
more often than men (23-30.3%) was caused by em-
bolism, p<0.0001. This data is confirmed referring to
the results received by H. Haimovici, Aune S., Illumi-
nati G. et al. (3, 10, 14).
The age difference results, which were obtained
by us, allow us to state that women experience the
acuteischemia in thelower limb whilebeing older (76.2
yeas old) than men (67.3 years old). Our principal
achieved results of age and quantity correspond the
results received by Becquemin JP Illiuminati G (12,
14) only there is difference in several years because
the lifetime in the authors’ countries is longer (Fig.5).
The expanded spectrum of operations in the case
of acute thrombosis allowed declining the quantity of
great amputations. This tendency was confirmed by
multicentral clinical study of Kuukasjarvi P, Salenius
JP (15). The results achieved by us approve the state-
ment that because of acute thrombosis there are
made more great amputations than in case of embo-
Fig. 4. Arterial occliusion location in lower limbs with acute ischemia
Numer of
patients
50
100
Patients age (years)
40–50 50–60 60–70 70–80 80–90
Fig. 5. The grouping of patients according to
the age
Acute thrombosis and
embolism location in
lower limbs
50
%
Iliac Femoral Poplitea Tibial
artery artery artery artery
100
50
embolism thrombosis
15.8
22.7
32.9
37.9
44.7
24.2
7 2

651
Fig. 6. The treatment algorithm of acute lower limbs ischemia (Rutherford RB, 2001)
lism (21). In comparison with foreign authors there
are made fewer great amputations caused by acute
ischemia in the lower limb in KUMH. Our achieved
results are compared with the data of foreign au-
thors in the Table 4.
The results achieved by different authors differ
broadly, the total death rate shown by Becquemin JP,
Kovarsky S is 15%(12), Illiuminati G with co-authors
stated the total death-rate was 25%(14), according to
the data of Kuukasjarvi P, Salenius JP the total death-
rate was 13%, in the group of thrombosis 6%, in the
group of emboli - 11% (15), the total death-rate got by
Neuzil DF, Edwards WH Jr and co-authors was 9.7%
(16, 18), according to Dale WA. data the death-rate in
the emboli group was 11%, and in the group of acute
thrombosis - 3% (17), Blaisdell FW, Steele M, Allen
Patient with
suspected acute
limb ischemia
Initial evaluation
-History
-Physical examination
-Doppler examination
Other diagnosis
Acute limb ischemia
confirmed and
staged
Heparin
I:viable
IIa:marginally
threatened
IIb:immediately
threatened
III:advanced/
”irreversible”
Early
intervention
appropriate
Arteriography
Surgical
treatment
Duration of
ischemia
Yes
No
Early
Delayed
amputation
Emergency
thrombembolectomy
Treat for
chronic limb
ischemia
Selected
appropriate
treatment
Catheter-
directed
thrombolysis
Ischemia worsens
or catheter-directed
thrombolysis fails
Arteriography:suc
cessful thrombus
removal
Underlying
lessions
Discrete,
localized
None
Multiple,
extensive
Anticoagula
nt therapy
Endovascular vs.
surgical
angioplasty
Yes
Bypass
No
Late

652
RE get that total death-rate is 7.5% (18), in Vilnius
University Blood-vessels surgery clinics because of
embolism in the limb there the death-rate was 10.8%
(22). To sum up the achieved results about acute is-
chemia treatment in the lower limb a lot of authors
state that heart diseases in the case of embolization
increase the death risk very much (1, 10, 17, 21) and
in the case of acute thrombosis there are made more
great amputations (1, 21). According to our data the
death rate of women is higher than men (5.5:1),
p=0.1198, but there are made more great amputations
for men (6:1), p=0.04250. That is confirmed by the
results achieved by Illuminati G (14). The research
results of different authors (11, 13, 15, 17, 18, 20) and
the treatment results of our research in the lower limb
of acute ischemia are given in the Table 2.
In our opinion, it is the most important to define the
time of acute ischemia in the limb exactly and evalu-
ate the state of its arterial – vein and neuromuscular
systems. The time of acute ischemia can be defined
after collecting anamnesis, objective research of a
patient, arterial – vein system can be evaluated during
the examination of the limb, while feeling blood-ves-
sels, examining arteries with an ultrasound device,
making angiography; the neuromuscular system is
evaluated while examining objectively (numbed
muscles of the limb, the disorder of limb movements
through the joints, superficial and deep disorder of dif-
ferent senses), while making the biopsy of limb
muscles. In KUMH Angiosurgery department there
is used R. B.Rutherford algorithm of acute ischemia
treatment in the limb (Fig.6).
Conclusions
1. In period of 1999–2001 in KUMH, in the
angiosurgery department, there were treated 142
(7.1%) patients because of acute ischemia in the lower
limb. The reason of acute ischemia in the leg was
embolism 53.5% and acute thrombosis – 46.5%.
2. Embolism is more often diagnosed in the femo-
ral and popliteal arteries, and the acute thrombosis –
in the femoral and iliac arteries.
3. Lower limb embolism of arteries is more com-
mon for women (2.5:1), p<0.0001, and acute throm-
bosis for men (3.5:1), p<0.0001. Older women are
more ill with this pathology than men.
4. If there is embolism in the lower limb, the death
rate is higher and in the case of acute thrombosis there
are made more great amputations.
5. The total death rate of women is higher than
men, p=0.1198, there are made more great amputa-
tion for men, p=0.04250.
Table 4. Major amputation rate of patients with embolism and acute thrombosis in lower limbs
Authors Reason of ischemia Major amputation rate (%)
F. Pellegrino (11) thrombosis 16
embolism 11
J. P. Becquenim (12) embolism 23
G. Illiuminati (14) thrombosis 37.7
embolism 17.2
P. Kuukasjarvi (15) thrombosis 26
embolism 10
D. F. Neuzil (16) embolism 7.4
Vilnius University (22) embolism 10
KUMH thrombosis 7.6
embolism 2.6
Apatinės galūnės ūminės išemijos chirurginis gydymas
Kauno medicinos universiteto klinikų Angiochirurgijos skyrius
Raktažodžiai: embolija, ūminė trombozė, operacija, ankstyvieji chirurginio gydymo rezultatai, statistinis
mirtingumas.

653
References
1. Dormandy J, Heeck L. Acute limb ischemia. Vig S. Eur J Vasc
Surg 1994;8(5):578-83.
2. Costantini V, Lenti M. Treatment of acute occlusion of pe-
ripheral arteries. Ann Acad Med Singapore 1994;23(6):844-7.
3. Haimovici H, Ascer E, Hollier LH, Strandness DE Jr, Towne
JB. In: Haimovici H, editor. Acute arterial thrombosis. 4th ed.
United States of America: Blackwell Science Press; 1996. p.
458-65.
4. Davies AH, editor. Vascular surgery highlights 1998–1999.
London: Oxford; 1999.
5. Chalmers RTA, Byrne D, Cross KS, Moores C, editors. Es-
sentials of vascular surgery. Scotland: Edinburg; 2000.
6. Cronenwett JL, Rutherford RB. Decision making in vascular
surgery. In: Lampert R, Robins CJ, editors. Acute limb ische-
mia. 1st ed. Philadelphia: Saunders Company Press; 2001. p.
168-70.
7. Lavenson GS, Rich NK, Baugh JH. Value of ultrasonic flow
detector in the management of peripheral vascular disease.
Am J Surgery 1970;120:522-6.
8. Rutherford RB, Baker JD, Ernst C, et al. Recommended stan-
dards for reports dealing with lower extremity ischemia. Jour-
nal Vascular Surgery 1997;26:517-38.
9. Verstraete M, Verghaeghe R, Belch J, et al. Thrombolysis in
management of lower extremity occlusion: a consensus docu-
ment. Am J Cardiology 1998;81:207-18.
10. Aune S, Trippestad A. Operative mortality and long-term
survival of patients operated on for acute lower limb lscha-
emia. Eur J Vasc Endovasc Surg 1998;15:143-6.
11. Pellegrino F.Acuteischemia of the extremities caused bythrom-
boembolism. Eur J Vasc Surg 1987;1(4):263-71.
12. Becquemin JP, Kovarsky S. Arterial emboli of the lower limbs:
analysis of risk factors for mortality and amputation. Asso-
ciation Universitaire de Recherche en Chirurgie. Riv Eur Sci
Med Farmacol 1996;18(1):19-27.
13. Stirnemann P, Z’Brun AP, Mahler F. Clinical aspects and treat-
ment of acute arterial occlusion. Arch Surg 1984; 119(7):784-
7.
14. Illuminati G, Bertagni A, Calio FG, Ciulli A, Guglielmi R,
Vietri F, Martinelli V. Acute ischemia of the lower limbs. Br J
Surg 1993;80(5):592-5.
15. Kuukasjarvi P, Salenius JP. Perioperative outcome of acute
lower limb ischaemia on the basis of the national vascular
registry. The Finnvasc Study Group. Am Surg 1997;63(3):
270-4.
16. Neuzil DF, Edwards WH Jr, Mulherin JL, Martin RS 3rd,
Bonau R, Eskind SJ, Naslund TC, Edwards WH Sr. Limb
ischemia: surgical therapy in acute arterial occlusion. Surg
Today 1998;28(2):156-61.
17. Dale WA. Differential management of acute peripheral arterial
ischemia. Semin Vasc Surg 1999;12(2):148-53.
18. Blaisdell FW, Steele M, Allen RE. Management of acute lower
extremity arterial ischemia due to embolism and thrombosis. J
Vasc Surg 1984;1(2):269-78.
19. Hobson RW. Acute limb ischaemia. Semin Vasc Surg 1992;
5:1-3.
20. Dale WA. Differential management of acute peripheral arterial
ischemia. Journal of Vascular Surgery 1984;2:1-15.
21. Cambria RP, Abbott WM. Acute arterial thrombosis of the
lower extremity. Its natural history contrasted with arterial
embolism. Ann Vasc Surg 1989;3(4):374-9.
22. Sučila M, Triponis V. Chirurginio gydymo prognozė sergant
galūnių arterijų embolija. (Preoperative prognosis of the risk
in patients with acute limb arterial embolism.) Medicinos
teorija ir praktika 2000;1(21):165-6.
Received 1 April 2003, accepted 16 May 2003
Santrauka. Darbo tikslas. Išanalizuoti apatinės galūnės ūminės išemijos chirurginio gydymo strategiją ir jo
rezultatus Kauno medicinos universiteto klinikųAngiochirurgijos skyriuje 1999–2001 m. laikotarpiu.
Tyrimo medžiaga ir metodai. Retrospektyviai renkant duomenis nustatyta, kad dėl ūminės galūnių išemijos
buvo operuoti 244 ligoniai (12,2 proc. visų ligonių). Dėl apatinės galūnės ūminės išemijos operuoti 142 (7,1
proc.) ligoniai. Visos embolijos ir trombozės buvo patvirtintos operacijos radiniais. Kiekybinių dydžių lyginimas
atliktas naudojant Stjudento (t) kriterijų.
Rezultatai. Ūminę išemiją kojoje sukėlė: embolija – 76 (53,5 proc.), ūminė trombozė – 66 (46,5 proc.)
ligoniams. Širdies liga embolijų atveju nustatyta 22,4 proc. ligonių, esant ūminei trombozei – 6,1 proc. Embolijų
lokalizacija: pakinklio arterijoje– 44,7 proc., šlaunies arterijoje – 32,9 proc., ūminės trombozės: šlaunies arterijoje
– 37,9 proc., klubo arterijoje – 22,7 proc. atvejų. Vyrams dažniau pasitaiko ūminė trombozė (3,5:1), p<0,0001, o
moterims – embolija (2,5:1), p<0,0001. Embolijos buvo gydomos embolektomijomis, o ūminės trombozės –
trombektomijomis, trombendarterektomijomis ir šuntavimo operacijomis. Didžiųjų amputacijų atlikta 4,9 proc. ir
išgelbėta 96,1 proc. apatinių galūnių su ūminės išemijos požymiais. Statistinis mirtingumas – 4,2 proc.
Išvados. Ūminė išemija kojoje dėl embolijos buvo 76, dėl ūminės trombozės – 66 ligoniams.Apatinių galūnių
arterijų embolija dažniau pasitaikėmoterims (p<0,0001), ūminė trombozė– vyrams (p<0,0001). Moterų, kurioms
nustatyta ūminė kojos išemija, mirtingumas didesnis negu vyrų (p=0,1198); vyrams, esant ūminei išemijai kojoje,
atliekama daugiau didžiųjų amputacijų (p=0,04250).
Adresas susirašinėjimui: N.Aleksynas, KMUKAngiochirurgijos skyrius, Eivenių 2, 3007 Kaunas
El. paštas: nalex@takas.lt

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