Acute Arterial Embolism of the Lower Extremities: Impact of 24-Hour Duration on the Outcome of Management
Pramook Mutirangura MD*, Chanean Ruangsetakit MD*, Chumpol Wongwanit MD*, Nuttawut Sermsathanasawadi MD*, Khamin Chinsakchai MD*
Affiliation : * Vascular Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Objective : Determine the impact of 24-hour duration of arterial embolism on the outcomes of management.
Material and Method: A prospective study of 91 patients with acute arterial embolism of the lower extremities
was carried out.
Results : Among the 91 patients, 31(34.1%) were with early acute embolism(< 24 hours) and 60 (65.9%) were
with late acute embolism (> 24 hours). Extensive limb gangrene was more common in patients with late acute
embolism (26.7% versus 3.2%, p = 0.009). Subsequently, primary major amputation was higher in those
patients (20% versus 3.2%, p = 0.05). In early acute embolism, surgical embolectomy was only the primary
treatment of revascularization (87.1%) whereas in late acute embolism, there were varying modalities of
revascularization (68.3%) in addition to surgical embolectomy. The successful revascularization after the
initial surgical embolectomy was significantly higher in patients with early acute embolism (92.6% versus
43.9%, p < 0.001). Patients with late acute embolism had a higher tendency of undergoing major amputation
after revascularization (24.4% versus 7.4%, p = 0.106). Successful outcome was higher in patients with early
acute embolism (83.9% versus 58.3%, p = 0.014).
Conclusion : The 24- hour duration of arterial embolism may be a crucial factor influencing the outcome in the
management of this disease.
Keywords : Arterial embolism, Acute ischemia, Lower extremity, 24 hour duration of embolism, Outcome of management
