The preoperative “route” of patients and the causes of delay in revascularization for acute lower limb ischaemia
DOI:
https://doi.org/10.52692/1857-0011.2024.2-79.24Keywords:
acute ischaemia , preoperative period, revascularization of extremitiesAbstract
Prompt revascularization in acute limb ischaemia (ALI) is an important measure to increase the limb salvage rate. The aim of the present research was to study the “route” of patients with ALI of the lower extremities from the onset of the first symptoms until revascularization procedure with the highlighting of the factors that condition its retention. The median value of the time interval “onset of ALI - calling for medical assistance” was 18 (IQR 4-71) hours; “request for medical help - initiation of anticoagulant treatment” - 2.5 (IQR 1-5) hours; “request - hospitalization” - 1 (IQR 1-2) hour; “hospitalization - revascularization” - 3.7 (IQR 2-8) hours. The most important factor that determined the delay of revascularization was the patient’s late referral for medical assistance. However, the time interval since the onset of ALI should not be considered an independent criterion for determining the treatment strategy and the chances of limb salvage.
References
Natarajan B., Patel P., Mukherjee A., Acute Lower Limb Ischemia-Etiology, Pathology, and Management. Int J Angiol, 2020; 29(3):168-74.
Setianto B.Y., Faisal A., Revascularization of Acute Limb Ischemia. Acta Cardiologia Indonesiana, 2020; 6(2):142-8.
Hage A.N., McDevitt J.L., Chick J.F.B., Vadlamudi V., Acute Limb Ischemia Therapies: When and How to Treat Endovascularly. Semin Intervent Radiol, 2018; 35(5):453-60.
Dilawari T.H., Farooqui F., Aimon S., Jehan M., Latif S., Late Presentation of Acute Limb Ischemia: Causes and Outcomes. J Coll Physicians Surg Pak, 2023; 33(1):103-6.
Henke P.K., Contemporary Management of Acute Limb Ischemia: Factors Associated with Amputation and In-hospital Mortality. Semin Vasc Surg, 2009; 22(1):34-40.
Björck M., Earnshaw J.J., Acosta S. et al., European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg, 2020; 59(2):173-218.
Casian D., Guțu E., Culiuc V., Smolnițchi R., Predenciuc A., Protocol Clinic Național nr. 388 „Ischemia Acută a Extremităților la Adult”. Ministerul Sănătății, Muncii și Protecției Sociale al Republicii Moldova, 2021; 60 p.
Langenskiöld M., Smidfelt K., Karlsson A., Bohm C., Herlitz J., Nordanstig J., Weak Links in the Early Chain of Care of Acute Lower Limb Ischaemia in Terms of Recognition and Emergency Management. Eur J Vasc Endovasc Surg, 2017; 54(2):235-40.
Londero L.S., Nørgaard B., Houlind K., Patient Delay is the Main Cause of Treatment Delay in Acute Limb Ischemia: An Investigation of Pre- and In-hospital Time Delay. World J Emerg Surg, 2014; 9(1):56.
Lukasiewicz A., Contemporary Management of Acute Lower Limb Ischemia: Determinants of Treatment Choice. J Clin Med, 2020; 9(5):1501.
Jivegård L., Holm J., Bergqvist D., Björck C.G., Björkman H., Brunius U. et al., Acute Lower Limb Ischemia: Failure of Anticoagulant Treatment to Improve One-month Results of Arterial Thromboembolectomy. A Prospective Randomized Multi-center Study. Surgery, 1991; 109(5):610-6.
Wang S.K., Murphy M.P., Gutwein A.R., Drucker N.A., Dalsing M.C., Motaganahalli R.L. et. al., Perioperative Outcomes are Adversely Affected by Poor Pretransfer Adherence to Acute Limb Ischemia Practice Guidelines. Ann Vasc Surg, 2018; 50:46-51.
Downloads
Published
License
Copyright (c) 2025 Bulletin of the Academy of Sciences of Moldova. Medical Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
