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Open AccessArticle

Contemporary Management of Acute Lower Limb Ischemia: Determinants of Treatment Choice

Department of Surgery, Provincial Specialty Hospital in Wloclawek, 87-800 Wloclawek, Poland
Department of Vascular Surgery, Regional Specialty Hospital in Grudziadz, 86-300 Grudziadz, Poland
J. Clin. Med. 2020, 9(5), 1501;
Received: 27 March 2020 / Revised: 2 May 2020 / Accepted: 15 May 2020 / Published: 16 May 2020
(This article belongs to the Section Vascular Medicine)
The role of endovascular procedures in the treatment of acute lower limb ischemia (ALI) is expanding. For treatment, the choice between surgical or endovascular is still debated. The aim of this study was to identify factors that determine the selection of treatment. This study included 307 ALI patients (209 with thrombosis). Patient details, factors affecting the procedure choice, and outcomes were analyzed. The majority of patients were operated on (52.4%). Surgery was more frequent in embolic patients with embolus (odds ratio (OR) 33.85; 95% confidence interval (CI) 6.22–184.19, p < 0.0001), severe ischemia (OR 1.79; 95% CI 1.2–2.66, p = 0.0041), and active cancer (OR 4.99; 95% CI 1.26–19.72, p = 0.02). Tibial arteries involvement was negatively related to surgery (OR 0.25; 95% CI 0.06–0.95, p = 0.04). The complications and amputation rates were comparable. Reinterventions were more common in the endovascular group (19 (20.2%) vs. 17 (8.9%), p = 0.007). The six-month mortality was higher in the operated patients (12.6% vs. 3.2%, respectively, p = 0.001). The determinants of the treatment path are ischemia severity, concurrent cancer, embolus, and peripheral lesion location. Modification of the Rutherford acute lower limb ischemia classification is required to improve the decision-making in patients with profound ischemia.
Keywords: acute limb ischemia; vascular surgery; endovascular; outcomes acute limb ischemia; vascular surgery; endovascular; outcomes
MDPI and ACS Style

Lukasiewicz, A. Contemporary Management of Acute Lower Limb Ischemia: Determinants of Treatment Choice. J. Clin. Med. 2020, 9, 1501.

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