Journal «Angiology and Vascular Surgery» • 

2010 • VOLUME 16 • №2

ACUTE THROMBOSIS OF LOWER-LIMB ARTERIES: CONTEMPORARY APPROACHES TO THERAPEUTIC DECISION MAKING

Zatevakhin I.I., Zolkin V.N., Gorbenko M.Yu.
City Clinical Hospital № 57 of the Public Health Department of the city of Moscow,
Chair of Surgical Diseases of the Paediatric Department, Russian State Medical University under the Russian Ministry of Public Health,
Moscow, Russia

Analysed herein are therapeutic outcomes in a total of 499 patients presenting with acute thrombosis of the aorta and lower-limb arteries and having previously no reconstructive operations on limb arteries on the affected side. Group I was composed of the patients who had during the first 24 hours of hospitalization undergone an emergency operation (n = 146), and Group II comprised those subjected to medical treatment only (n = 353).

In Group I, the number of the patients who survived with a preserved extremity amounted to 91.5% of those presenting with grade I ischaemia, equalling 76.5% of those diagnosed with grade IIA, 48.5% of those having grade IIB, and 12.5% for those with grade IIIA. Using conservative measures alone, we had managed to attain complete regression of acute ischaemia in as few as 38% of patients found to have grade I ischaemia and in only 1.5% of grade II patients, with the remaining subjects found to either continue suffering from ischaemic impairments or even have them progressed, which later on required performing a reconstructive operation or primary amputation. The outcomes of surgery in patients operated on later than the first 24 hours after admission to hospital were also much worse: the number of amputations was two times higher as compared with that in Group I. The statistical analysis showed a significant dependence of the acute ischaemia pattern on localization and dissemination of the occlusive lesion.

Hence, an emergency reconstructive operation appears to be treatment of choice for acute thromboses of lower limb arteries. An exception may only be made for patients presenting with grade I acute ischaemia, running high operative risk, and having a favourable prognosis of the acute ischaemia course, based on the data concerning localization of the occlusive lesion.

KEY WORDS: acute thrombosis, aorta and lowe-limb arterie, decision making.

P. 138

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